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PO Box 73 i U <br />S~yiy Sulem Oregon <br />Q~(~/(~ 97303-0088 <br />SERVICES INC Garten Services, Inc. - Recycling Division PB (so3>ssl-at7z <br />Records Destruction Services Receipt / Certificate <br />CUSTOMER TO COMPLETE <br />SHADED AREA <br />v~ <br />Account # 3 C ? 450 <br />Stele Agency? D Yes Q-No <br />AUTHORIZE O <br />J <br />Customer Name: (NO ABBREVIATION <br />S please) <br />- please include department & division <br />( ign) <br />o F rJe <br />kttnd'ts <br />r h~ 1 <br />(Pledse print clearly) <br />Recottle Descnption (for your reference). <br />Billing Address: <br />Phone # <br />V~v <br />Witness Destruction Needed? ❑ Yes ❑ No <br />Customer PO # <br />Signature of Witness. <br />TRANSPORTATION USE ONLY <br />Driver's Name :,)IC <br /> <br /> <br />f <br />Date of Pick-up: <br />~ <br />• <br />Type of Records: <br />Paper <br /># of Pallets/Gaylords <br />Plastic <br /># of Roll Cans <br />E-Recycle <br /># of Barrels <br />Other <br /># of boxes <br />describe other <br /># of units <br />DOCK USE ONLY <br />j <br />' <br />s Name: <br />Dock Clerk <br />Date Accepted: <br />! - 1 <br />Delivered: <br />cked-Up: <br />Q <br />Type of Records: <br />Weight: <br />A <br />Lot <br />E <br />SHREDDING DEPT. USE ONLY <br />Method of Destruction <br />tCertified by signature: <br />- <br />(Print Name) <br />«s <br />rr1---''--III <br />Non NAID Cart. <br />Destruction type <br />Paper Plastic E-Recycle Other <br />Shred <br />Date Destroyed: <br />Incineration <br />Secure Data Wipe Q <br />Physically Destroy <br />ACCOUNTING USE ONLY <br />Cash Customer Payment: <br />Amt. Paid $ <br />Recd by _ Date <br />Check At <br />Cash: <br />White - Original <br />Yellow - Invoice Copy <br />Pink - Customer Copy <br />