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CSG SK- SSL-B0X- 24 Steve Mullan 02 / 14 / 17 15 : 33 PAGE 1 <br /> Safety = Kleen Systems , Inc . <br /> 2600 N Central Expy , Suite 200 <br /> Richardson , TX 75080 <br /> CORPORATE : 800 - 669 -5740 <br /> 24 HR EMERGENCY : 800 - 468 - 1760 ( Safety-Kleen ) <br /> 2095451011 <br /> REFERENCE NBR , <br /> CUSTOMER # G011213 Gordon Trucking Inc 72634555 - 1700281920 <br /> 12550 S Harlan Rd SRVC WEEK : 2017 - 4 <br /> Attn Bob SRVC DATE : 02 / 14 / 17 15 : 32 <br /> Lathrop CA 95330 - 8744 <br /> PHONE 209 - 640 - 0555 <br /> BILL TO CUSTOMER# BILL TO ADDRESS : '.. <br /> G011880 Gordon Trucking Inc <br /> 151 Stewart Rd Sw <br /> Pacific WA 98047 - 2108 <br /> PHONE 999 - 999 - 9999 <br /> PURCHASE ORDER# TAX EXEMPT # <br /> PRODUCT/SERVICES <br /> SERVICE / TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE '.. <br /> 3383 DRUM , 55 GAL FOR O . F . 1 . 000 10 . 0000 0 . 00 10 . 00 <br /> SERVICE TERM 8 WEEK <br /> 83383 DRUM , 55 WASTE O . F . 1 . 000 58 . 0000 0 . 00 58 . 00 <br /> SERVICE TERM 8 WEEK <br /> 898560 CARTRIDGE OIL FILTERS 55G 4 . 000 250 . 0000 0 . 00 1000 . 00 <br /> SERVICE TERM 8 WEEK <br /> # CONTS : 4 TSDF : WI MANIFEST # : 005863032SKS FORM CD : US SHIP # 221595793 <br /> CNT # : 170201958206 QTY : 150 WT /VOL P PROF# 156777 SKDOT 7612003 <br /> CNT # : 170201958205 QTY : 150 WT /VOL P PROF# 156777 SKDOT 7612003 <br /> CNT # : 170201958204 QTY : 150 WT /VOL P PROF# 156777 SKDOT 7612003 <br /> CNT # : 170201958203 QTY : 150 WT /VOL P PROF # 156777 SKDOT 7612003 <br /> 8003369 DRUM , 55 GL BLACK STEEL 0 4 . 000 76 . 0000 26 . 60 330 . 60 <br /> SERVICE TERM 8 WEEK <br /> 100001 FEE , FUEL SURCHARGE 1 . 000 10 . 8300 0 . 95 11 . 78 <br /> 3230 TAX HANDLING N / C DRUM DROP 30 1 . 000 0 . 0000 0 . 00 0 . 00 <br /> TOTAL SERVICE / PRODUCTS 404 . 8300 27 . 55 1410 . 38 <br /> TOTAL CHARGE 1410 . 38 <br /> CREDITS 0 . 00 <br /> - ------- ---- - <br /> TOTAL DUE 1410 . 38 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 1410 . 38 <br /> GENERATOR STATUS <br /> 0 -220 lbs /month <br /> Customer certifies that ( i ) the above- named materials are properly <br /> classified , packaged , marked and labeled , and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Department of Transportation ( ii ) no material change has occurred <br /> either in the characteristics of the waste /material or in the process <br /> generating the waste /material , and ( iii ) the above referenced <br /> Generator Status is correct . Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions ( 1 ) set forth in ( a ) the <br /> General Terms and Conditions provided separately to Customer or ( b ) <br /> any SK agreement signed by Customer and SK , and ( 2 ) incorporated <br /> herein by reference . Unless otherwise indicated in the payment <br /> received section , SK is authorized to charge Customer ' s account for <br /> this transaction . If Customer fails to make payment when due , an <br /> amount equal to the lesser of ( i ) 1 . 5 % per month ( 18 % per annum ) or <br /> ( ii ) the maximum amount allowed by law , will be added to all unpaid <br />