HomeMy WebLinkAboutfuel/oil/tank info `,,.- - a Mir�nesota /�etro%um
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PS`�"E6M Service Work Order 682- 39th Avenue NE, Columbia Heights, MN 55421
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"Service After The Sa�e" Phone: (763) T80-5191 www.mnpetro.com
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Date: %�' '� i 3� � ' ' r"`� , Work Order# Warranty (Circle)
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f' YES or NO
Company: � r'�'' °� �r'' �''��� '�����r �"�': � �`� � Customer PO #
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Contact: � `
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3treet: Phone: �'� � +�`�'_� ' � �----Warranty Report #______
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City __ ,�,__';�—T-- �._,-r '�� -,- State: _ Zip• — --
Red Jacket Veeder Root
EQU/PMENT(M[JST BE P/LLED OUTJ Wayne Tokheim Gi/barco Bennett Sch/umb Pi//-Rite VeriFone PetioVend Linco/n EMCO
Other: Model Number: Serial #_ __
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Servlce Requested: � � ;� , �,: , � � �..e,. .-`.-,;� _;1' �� . ,�-_.: " � '=�^'' E .� %� °`�`' '`� ,'.
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Service Perforrr►ed: /� �,�.�� � .�f ,, - "'�_.�,� � �
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Part Number Description B/O Qty New Serial # Old Serial # Price Total Amount
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Parts & Materials
Departure Time: Total Hours Tax
Arrival Time: Labor
Departure Time: Job Complete Mobilization
Arrival Time: Yes No Total Due
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� Customer Acknowledgement_ " - ~�e � ..� Thank You For Your Business
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OO Copyright 2007 J.J.KELLER&ASSOCIATES,INC.,Neenah,WI•USA•(800)327-6868•www.jjkeller.com•Printed in the UnitAd States
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TH IS M EMORAN DU M �s an acknowledgement that a bitl of latlinq has been issued and is not ihe Original BIII of Latling,not a copy p
or duplicate,covering the pmperty named herein,antl is intentled solery for filing or recortl.
Shipper's No.
Carrier '��"�`����������''�`��'�-& ~�<����'�� SCAC Carrier's No. �����
RECEIVED,subject to individually determined rates or contracts that have been agreed upon in writing between the carrier and shipper,if applicable,othenvise to the rates,classifications and ruies that have been
established by the carrier and are available to the shipper,on request;and all applicabie state and federal rggulatio�. f
at �..���w��t��fi'�, �s� , date ��'' � �� from '
the Property tlescribed below,in apparent gootl ortler,exce0�as notetl(conlents antl contlinon of coments of packages unknown),marketl.consigned and destined as intlicatetl below whlch saitl company(Ihe word company being untlers�ootl ihroughout chis
coniract as meaning any person or corpoiat�ion in possession of t�e property untler the contrac�)agrees to carry�o tlelivery at saitl tleslination,il on its route,or otherwise to tleliver to another carrier on lhe roule ro said tlestination.It is mutually agreed as to each �
carrier of all or any ot saitl Property over all or any portion ot saitl route Io destination antl as to each parry at any time interestetl in all or any of saitl Properry that every service to be peAortnetl hereuntler shall be subjea ro ali ihe contlitions not prohlbiretl by law, �
vahefher prin�etl or wntfEn,herein ContainEtl,inClutling the Contlition5 on lhe baCk hereof.whlch are hereby a9reetl t0 by the S�ippef and aCCepietl lor himsel(entl hiS ZSSigns.
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Co�nsignee ��i�����:�t��E'!4'��l��`;%..�.�.o���s,���`:, SROMr 4�_- } � ,... a � ,� �,� # ;`
Street ����`��.°�. �.�. Street �� f �a -�-:-',,"_?1�ca 1 �" ���,�„ �u'
Destination �;�,��,��$������¢�'�'�,�� Zip ����� Origin �:,J;�;4 `�°C, 1^r1 �'�` Zip
Route
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♦ ♦ Subject�o Section 7 of conditions,if Ihis COD FEE.
RP.CT�IL COD lO. shipment is to be delivered to ihe consi9nee �OD AMT:
A,.1,.1 without reCourSB on the ConsiynOf, ihe
UUreSS. consignorshallsignthefollowingstatemeM: P(2 aid ❑
♦ The carrier shall noi make tlelivery of this rh p
Clly. StGZtP.. ZIP. shipment without payment of freight antl all �y �
otherlawfulcharges. C���QCt �
NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing TOTAL CHARGES: FREIGHT CHARGES'
the agreed or declared value of the property.The agreed or declared value of the property is •
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hereby specifically stated by the shipper to be not exceeding $ Per .:��.�,->���s or Co�s�g�o�) __——__.._ ❑ Pfepaid ❑C0110Ct
ee49US0.
NOTE Liability LimitaLon for loss or damage m this shipmeM may be applicable S • � •r
14706(c)(1)(A)and(B). . ,� j � .. � �BY SHIPPER ��BY CARRIER
T �ci i� a �+� � � 5 '�ec� k�ge n �.. '� {"�
. . �c . . -- __oF,ic�b� ag�ile.� s o 'he P � ! `� � � DRIVER�S ��. ?�,�,f � ��,,�i
D_�� t � ..., i -. .., � SIGNATURE '+:,..�i.`• : a{ if.
SHIPPER: tf, CARRIER:, "' � �`� ``�r'-= `�
�'� � - �'�'�;� PER:� 'r' ;�k: ,� =' DATE: �'- ,�-
PE�i:-- : DATE:3^T'� .
E:.%iEKGE�I Y RCSPC��lSE ��`� �vionit�,�ed a �II ,ir*�rs the Hazardous��'ate�ia s:+�iransponaiion
'tELEP1-IONE NUMB�: � ,�,��: `� ) "� j`� ' �;� i �nc'u�,ng s,c a�e �idental to transpertation!'i2.o04).
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Ordered by: � F'- , Site Contact:
Phone: ( ) Phone: ( )
CUSTOMER P!O DATE ORDERED DATE COMPLETED VIA INVOICE DATE
CUSTOMER# UNIT# LIC# WRITTEN BY LP HAZ MAT FIELD BID
"" ' " SHOP. ,. WMETER YES NC
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--' -' �, , ,, ESTIMATED COSTS:
�'�� ` LABOR HOURS RATE �
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� MATEAIAL
'� OTHER
`� '��� � SUBCONTRACTORS
� � � ��� TOTAL ESTIMATED COST
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" MARGIN / $
, LUMP SUM T&M(NTE) TOTAL$
QUAN REMAINING MATERIAL NEEDED FOR JOB EQUIPMENT CHECKIIST
FRESH AIR EQUIPMENT
DIAPHRAGM PUMP SERVICE CHARGE
AIR COMPRESSOR SUBCONTRACT
LADDER PRODUCT DISPOSAL
100 GALLON PROVER TANK DISPOSAL
500 GALLON PROVER SUBSISTENCE
1000 GALLON PROVER SHOP SUPPLIES
LEL MATERIALS
WELDER EQUIPMENT RENT
VENTURI WELDER RENT
POWER VISE STATE SALES TAX
AIR SAW FREIGHT
HOSE REQUIRED STEAMING
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AIR DRILL LABOR HRS /HR
PRESSURE WASHER LABOR HRS /HR
CONCRETE MIXER LABOR HRS /HR
SCAVENGER LABOR HRS ;HR
CELLPHONE LABOR HRS ;HR
HARD HATS LABOR HRS /HR
TOTAL
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