home page - the superior court of california, county of santa clara€¦ · july 06130111 07/01/11...
TRANSCRIPT
Month REQ DATE
DEL'Y DATE REQ'ED BY UNIT ft Ineoice# II RANCH tYPE VENDOR
Actual Price Cony kr tt Gal Cony kr $ , -
2012 AO 04/12/12 04/13/1A Atnantlo Espinosa SR16 737664 Doctor 0 Wholesee 33188 3584 $12,321.64
2011 May 05124111 05125111 Armando Espinoza 8R16 708496 Doctor D Wholesale 3.1015 3547 $11401.07 July 06130111 07/01/11 Armando Espinoza SR16 711440 Doctor D Wholesale 3.1160 2472 $7,980.26
2010 April 04119110 04/20/10 Armando Espinoza SR16 679627 Doctor D Wholesale 23060 2583 $6175.60 June 06101110 05102310 Armando Espinoza SR1 -5 816560 Doctor 0 Fleet 2.1294 3493 $$067.10 June 06101110 06102/10 Armando Espinoza SW 819114 Doctor J D Fleet 2.1294 558 $1 8E1.70 July 07107110 07108/10 Arrnando Espinoza SR15 824015 Doctor D Fleet 2.9612 3950 $8,1330.93 December 12/06)10 12107/10 Armando Espinoza SRI& 696513 Doctor 0 Wholesale 2.56211 3795 $10939.89
2009 December 12104/09 12105109 Armando Espinoza SR15 62089 Doctor D Schwehel 2.0450 3700 $7,842.18
1172
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Doctor Diesel 2012-2009 Doctor Records for 2009-2012
01/11/13
JAN-29-2013 11:06
From:818-347-8670
WEST HILLS HOSPITAL
Pace:3/17
Wholesale Fuels Inc ACCOUNTING OFFICE P.O. Box 82277 Bakersfield, CA 93380-2277
Phone: 661-393-7000 FaX 661-633-7563
Sold GRIMNWAY ENTERPRISES/MASTER To: ACCOUNTS PAYABLE
P. O. BOX 81498 BAKERSFIELD, CA 93380-1498
Page: 1
Invoice No: 737664 Invoice Date: 04/13/12 Ship Date: 04/13/12
Profit Center: 2533
Ship GRIMMWAY ENTERPRISES, DOCTOR To: AVENUE M s 60TH ST EAST
LANCASTER, CA
Account No:26630832 PO No: Terms: NET 30 DAYS Ship Via:COX TRANSPORTATION Sales 1D12
ROL/Ship.Order:
Product Code/
Quantity Price Description
Shipped Hach ExtenSiOn
B/L Number-- 918063 T: 121 S: 37040296 4# Diese1,3,NA1993,PGIII,Combustible Liquid gg This i8 dyed Diesel fuel, nontaxable use 44 only. Penalty for taxable use. This fuel fg meeta EPA requirement for sulfur, cetane gg index, or aromatic content. gg May contain up to 4.9% bio-diesel
JaU '
ApR 21 21112
IF1/4-6CSLE,
3.318800 11,894.58
0.001000 3.58
0.001900 6.81
1.500000% 178.57
2.000000* 238.10
Total AMOUnt:
12,321.64
M-0 12- - ?A (Dos o
70 DYED CARB DIESEL
Fed LUST Tax Dsl/Chg Fed Envrnmntl Pee Dsl/Chg L.A. S/T Dsl\Chg CA Partial Sales Tax Diesel/Y
3,584.0
SPILLS OR LEAKS ONLY (42 GALLONS OR MORE) EMERGENCY CONTACT - 1st call PERS 1-800-633-8253 5‘
WACO BiC8FLD
ORIG. IRRIG G/S PM OONII IRRIG S/s FM/ ORIG, HARVEST
CONV. HARVEST 1
Page: 1
Invoice No: 708496 Invoice Date! 05/25/11 Ship Dates 05/25/11
A IN 1 0 2011
3.10 0.001190 0.001000 0.001900 1.500000% 2.0000006
_CIS PAYABLE 4.22 3.55 6.74
165.23 220.31
JAN-29-2013 11:06
From:818-347-8670
WEST HILLS HOSPITAL
Pa9e:4/17
Wholesale Fuels Inc ACCOUNTING OFFICE P.O. Box 82277 Rakersfield, CA 93380-2277
Phone: 661-393-7000 Fax: 661-633-7563
Sold GRIMMWAV ENTERPRISES/MASTER To! ACCOUNTS PAYABLE
P. 0. BOX 81498 BAKERSFIELD, CA 93380-1498
Profit Center: 1533
Ship GRIMMWAY ENTERPRISES To: DOCTOR RANrir
TANK SR16 AVENUE—r& 60TH ST EAST
Account No:26630832 PO No: Se, 'co Terms: NET 30 DAYS Ship Via:ELITR FUELS TRANSPORT, I Sales ID:12
BOL/Ship.Order:
Product Code/ Description
Quantity Price Shipped Eac Extension
B/II Number-- 371920 T: 129 S: 57180207 #4 Diese1,3,NA1993,PGIII,Combustible Liquid #4 This is dyed Diesel fuel, nontaxable use #0 only. Penalty for taxable use - This fuel 44 meets EPA requirement for sulfur, cetane 4# index, or aromatic content.
70 DYED CARS DIESEL
CA Oil Spill 0.00119/Chg Fed LUST Tax Dsl/Chg FedEnv-xi-multi Fee Del/Chg L.A. S/T Dsl\Chg CA Partial sales Tax Diesel/V
3,547-0
Total Amount: 11,401.07
Y k 61
F.E.11( 0(1 -filOOS- -01-1-9c -0(
SPILLS OR LEAKS ONLY f42 OALLONS OR MORE) Q/0 EMERGENCY CONTACT - 1st call PERS 1-800-633-8253 TRACO EIXBR.0 -------
- ORIG IRRIG S/S FM . 10P CONV. IRRIG S/S FiW
ORIG, HARVEST
CONV. HARVEST
Total Amount: 7,980.26
AGCTS 17V:ti\BLE
Fa - 21005- (32:25En - CD
JAN-29-2013 11:06 From:818-347-8670
WEST HILLS HOSPITAL Paoe:5/17
Wholesale Fuels Inc ACCOUNTING OFFICE P.O. Box 82277 Bakersfield, CA 93380-2277
Phone: 661-353-7000 FAX: 661-633-7563
Sold GRIMMWAY ENTERPRISES/MASTER TO: ACCOUNTS PAYABLE
P. O. SOX 81498 BAKERSFIELD, CA 93380-1498
Account No:26630832 PO No:
hig\oro; ett Invoice No: 711440 Invoice Date: 07/01/11 Ship Date: 07/01/11
Profit Center: 1533
Ship GRIMMWAY ENTERPRISES, DOCTOR To: AVENUE M & 60TH ST EAST------
LANCASTER, CA
Terms: NET 30 DAYS Ship Via:Pacifie West Coast Trans Sales ID:12 EOL/Ship.Order:
Product Code/ Quantity Price Description
Shipped Each
Extension
B/L Number-- 985122 T: 121 S: 37040296 ## Diese1,3,NA1993,PGIII,Combustible Liquid #* This is dyed Diesel fuel, nontaxable use
only. Penalty for taxable use. This fuel ## meets EPA requirement for sulfur, cetane ## index, or aromatic content.
70 DYED CARD DIESEL 2,472.0
CA Oil Spill #.00119/Chg Fed LUST Tax Dsl/Chg Fed Envrnmntl Fee D81/Chg L.A. S/T Osl\Chg CA Partial Sales Tax Diesel/Y
3.115000 7,700.28
0.001150 2.94
0.001000 2.47
0.001900 4,70
1.500000% 115.66
2.000000% 154.21
(3 SPILLS OR LEAKS ONLY (42 GALLoNs OR MORE) EMERGENCY CONTACT - let call PERS 1-800-633-8253 WACO BoRD
ORGJPSIG SA; FAN
OONVJRFOG SA; FAN
ORIG. HARVEST CONN. HARVEST
JAN -29-2013 11:06 From:818 -347-8670 WEST HILLS HOSPITAL Page:6/17
APR 2 790, Wholesale Fuels I c A iTA-F-. ACCOUNTING OFFIC P.O. Box 82277 L.
Bakersfield, CA 93380- 2277
Phone: (6611 393-7000 Fax: (661) 633-7563
0113m,,a, Page: 1
Invoice No; 679627 Invoice Date: 04/20/10 Ship Date: 04/20/10
Profit Center: 1533
in
Sold GRIMMWAY ENTERPRISES/MASTER To: ACCOUNTS PAYABLE
P. O. BOX 81498 BAKERSFIELD, CA 93380-1498
Ship GRIMMWAY ENTERPRISES, DOCTOR To: AVENUE M & 60TH ST EAST
LANCASTER, CA
Account No:26630832 PO No: ShipVia:WHOLESALE FUELS, INC. Sales ID; 12 BoidshIp.order:
s9- IL9 Terms: NET 30 DAYS
Product Code/ Description
Quantity Price Shipped Each Extension
B/L Number-- 903572 T: 121 5: 37040296 9% Diese1,3,NA1993,PGIII,Combustible Liquid 89 This is dyed Diesel fuel, nontaxable use CI only. Penalty for taxable use. This fuel @if meets EPA requirement for sulfur, cetane 8# index, or aromatic content.
70 DYED CARS DIESEL
L.A. SIT Dsl\Chg CA Partial Sales Tax Diesel/Y Fed Envrnmntl Fee Dsl/Chg Fed LUST Tax Dsl/Chg CA Oil Spill @.00119/Chg
2,583.0
2.306000 5,956.40
1.500000% 89.50
2.000000% 119.34
0.001900 4.91
0.001000 2.58
0.001190 3.07
Total Amount: 6,175.80
yta
FE (Item 12.looS 02-1-qc
SPILLS OR LEAKS ONLY (42 GALLONS OR MORE) EMERGENCY CONTACT - 1st call eEKS 1-800-633-8253
JAN-29-2013 11:06 From:818-347-8670 WEST HILLS HOSPITAL Paoe:7/17
Tax Code Description PRODUCT TAX SUMMARY
Tax Type Base QtY gate Tax Amount
629.11 Total Taxes * THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIDENCE OF DYE *
IN 1 6 2010
Product
23 FRTD
Description
ULSO GARB *2 DYED FREIGHT - DIESEL
3,491.00000 3,493.00000
ki0u:entity Unit Price
2.12940 0.00000
0501 State Sales Tax Percentage 0703 Superfund Tax - Diesel Per Gallon 0803 Environmental /gal - Diesel Per Gallon 1203 State Sales TAX OF Percentage 1204 State Sates Tax Other Percentage 2103 Federal LUST - Diesel Per gallon
0.000000 0.00
0.001900 6.64
0.001190 4.16
6.250000 465.77
2.000000 149.05
0.001000 3.49
ct" €.04,1•11D -Fzi (010 - 0°5 -15a-a-ctS — 01
3,493.00000 1,491.00000
3,493.00000
Taxes Deposits Total
629.11 0.00 8,067.10
Total Due: 8,067.10
Invoice: 816560 Date: 06/02/10
DUA Data: 06/22/10 SOL N: 837920
Order #: 46658 CUst PO: eel
La-v. ces_siceir
BILL TO: 500176-0 4R1MNNAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
MARTO
FLEET CARDIFFUELS
Remittance Stub GRIMMUAY ENTERPRISES, INC. 500176-0
06/02/10
Pay This Amount 8,067.10
Page 1
P.O. BOX 81685•BAKERSFIELO, CA 93380-1685 (661) 321-9961 -
6/470.Ma SHIP TO: 500176-0 GRIMMRAY ENTERPRISES, INC. P.O. BOX 81494 BAKERSFIELD, CA 93380
• \P-1/2.-----.119—tiler
Invoice: 816560 ere
ACCTS PAYABLE
SHIP TO: 500176-0 GRIKHWAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
BILL TO: 500176-0 ORDWAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
corar
sei -cloekte
u,AS • b2 124r5-.16
Quatity Unit Price Product Description Taxes Deposits Total
274.29 0.00
100.50 0.00
3,517.37
1,288.71
4.806.08 Total Due:
Rate TIM AMOUnt Tex Code Description PRODUCT TAX SUMMARY
Tax Type BaseCity
FLEET CARDOFUELS P.O. sox 81685•13AKERSFIELD, CA 93380-1685
(661) 321-9961
0/75:5855-
Invoice: 819114 Date: 06/02/10
Due Date: 06/22/10 BOL 0: 837882
Order $1; 47236 Cust POI 2E15/2100
St Laxiattleir rre cl-r—sL
23 tun CAR8 42 DYED FRYD FREIGHT -DIESEL 23 ULM) CARE #2 DYED FRTD FREIGHT - DIESEL
SO'S 1,523.00000 1,523.00000
.52.1b 558.00000 558.00000
;Z:itt
2. 1 2940 0,' 0.00000 2.12940 •*--- 0.00000
JAN-29-2013 11:07 From:818-347-8670 WEST HILLS HOSPITAL Pa9e:8/17
REMITTO
0501 State Sales Tax Percentage 0703 Federal Oil Spill - Dieael Per Gallon 0803 Env (Oil Spill) - Diesel Per Getlon 1203 State Sakes Tax OF Percentage 1204 State Sales Tax Other Percentage 2103 Federal LUST - Diesel Per Gel Ion
Total Taxes • THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIDENCE OF DYE • • THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIDENCE OF DYE *
0.000000 0.00
2,081.00000
0.001900 3.95
2,081.00000
0.001190 2.47
6.250000 277.49
2.000000 88.80
2,081.00000
0.001000 2.08
374.79
4%•04, cow - viloos - owis
RetatiA)
**miss ******* ss Remittance Stub
GRIMNWAY ENTERPRISES. 500176-0
06/02/10 /
INC.
Invoice: 819114 / .7 This Amount 4,806.08
Page 1
Invoice: 819114 Date: 06/02/10
Due Date: maxim DOL 8: 837882
Order f: 47236 Cunt PO:0615/2100
se- Lancasi-er
SILL TO: 500176-0 SRIMMWAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
Product
23 FRYD 23 FRIO
ULSD CARS 02 DYED FREIGHT - DIESEL ULSD CARS f2 DYED FREIBHT • DIESEL
1,623.00000 1,523.00000
558.00000 558.00000
2.12940 Ver 0.00000 2.12940 a' 0.00000
Description Oueritity Unit Price
SNIP TO: 500176-0 GRIMMWAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
Taxes
Depos1 ts
Total
274.29 0.00
100.50 0.00
Total Due:
3,517.37
1,288.71
4,006.08
JAN-29-2013 11:07
From:818-347-8670 WEST HILLS HOSPITAL
Paoe:9'17
REMIT TO
sets fur 6e t„boct-bi rx'16 FLEET CARDOFU ELS
PO, BOX 81685•SAICERSFIELD, CA 93380-1685 (661)321-9961
ecirreoka. gals bittest,
PRODUCT TAM Tax Type
SUMMARY Base City Rate Tex Anent Tax Code DeaCriPtion
0501 State Wee Tax 0703 Federat Oil Spill - Diesel 08T1 Env (Oil Spill) - Diesel 1203 State Sales Tax DF 1204 Stets Sales Tax Other
• 2103 Federal LUST - Diesel
Total taxes • THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIOENCE OF DYE * + THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIDENCE OF DYE *
0.0001100 -
0.00 2,081.00000 0.001900 3.95 2,emonotio (Looms 2.47
6.250000 277.49 2.000000 88.80
2,081.00000 0.001000 2.08
374.79
Percentege Par Gallon Per Gal lea Percentage Percentage Par Gallon
nanr******************.eaanannae.5*1..,5*.arataare****e.*********************4 Remittance Stub ORIMPSWAY ENTERPRISES, INC. 500176-0
06/02/10 Invoice: 819114
At.*
Pey This Moult 4,506.08
Pala 1
) . ENELIVERVIIMET
4-HOUR HAZMAT EMERGENCY RESPONSE (800) 728-2482
7 t
WEST HILLS HOSPITAL Pa9e:10/17 JAN-29-2013 11:07 From:818-347-8670
r4M..)•/fri UJ TANK LINZ'S I N C
P.O. BOX 81446 BAKERSFIELD, CA 93380 (661) 328-9041 (661)328-9045 FAX . Deliver To:
CS\IS 4irvAda4kseet idenwe toreencite .esbeell
Ina .0~77.74 I. 4 4# , ( s e Iiii Origin/Rack
BIN To:
An clitugavft...v.27NA .meAt774. f/. ted.*SV I
nfirligill Order Number Date • P.O. Number Truck It Trailer if , Driver
9b? 7t Ti" 1-2-le, if 4),
red Tank Readings
Product/ Deseripdon Qty Ordered la 1 HTR # Gross Canons Net Gallons Before After
RepuIar 87
Sit lip Mirigrade 89 151412o --mh. 5 A k ' cirTa Premium 91 •
1AS-1:Hist! V.017 10402- i
Da$) y Dyed ULS Meser7. Zill •"; uee, t TWAY i tiarr U4-1-/:
ra-v
3"..s;V" A ir g le 24 lratt
ORCIE ALL THAT APPLY .
EXPLANATION OF ADDMONAL CHARGES . •
1. Split toad 6. Stop in Transit ■ s 7Ctoll
Load
a stiv-,'
8. No Load
Ants slaw.* S. 2 i r
a.___--..„___ Stet-. ,,,,,r
aR Ire.
4. Station Pumpout
5:ExcessIve Load/Unload Time (Demurrage)
Time taken for demurrage: COMPARTMENTS LOADED 4s:
) a 2
If you only have 3 compartments, put an 'X" In compartment #4.
Rack Hours Anived Load Time
The Start Finish
fi #0 X_ ,P., 47 PI ye 51 c Z Delivery Hours
Arrived Unload Time Time Start Finish
t: All 68 Se 0 0
' API 'PM
Trip saes Loaned ‘• End Start , Total
3552 10 V censer
Received above produc s and service in good order
Received by:
JAN-29-2013 11:08 From:818-347-8670 WEST HILLS HOSPITAL Pa9e:11/17
.aNimpimmvemmumnALEMEROENcy /cm, oil Amp sing
• Mae
RMUSEMLEsignonaddlat CALLCHEEREC2-2
SHIPPER'S PERMANENT ADDRESS DELIVERY RECE/PT CHEVRON PRODLCTS COMPAKW CHARGE BALE - NORMAL 6001 BOLLINGER CANYON RD. DOCUMENT NO.: 837002 SAN AMON. CA 945BX DELIVERY DATE: 06/02/10 11126 4172 • FEIN; PrO527925 ACCOUNT NO.: 8240817
TRANSFEROR CARD1
SHIP FLIES CAR FUELS DORED BROM MONTEBELLO CA TRM,-1001654
10: DANIA TERMINAL FOB ORIGIN FREIGHT COLLECT 22858 FOB: BANTA TERMINA NKLA ,BULK TRANSPORT FEIN: 95211789i9 mammy) CA 70640 po BOX 01446- FEIN: 770267495 BAKERSFIELD ' 130 957e0
VIA NIKOLAUS TAW( LINES INC
140492 C-1001654-000000-060210-1001654 - -00885624700
hodm10e0mwan - GitHaelyt WO% . SAS OIL. COMBUSTIBLE LIQUID1 UN1202. III 339.7.m. eALLows . ,CALCO ILS SPECIAL DF2 DYED 3399.00 NX64.00 . moss LOA= AT 02 DECREES F,NET COMPUTED AT 60 MOMS r., 36.$0 API GRAVITY CALIFORNIA DIESEL FUEL. MAXIM(M 15 PP% SULFUR. DYED DIESEL FUEL. NONTAXABLE USE ONLY.
''''W'F.RENALTY FOR TAXABLE USE. - •DIEGEL FIBS. DELIVERED NOT INTENDED FOR MARINE . M.
CPA DIESEL REGISTRATION NUMBER 5096 SIOZO ' •
Cleton mod mattlin
1\435-( AciAnk
.atralahlIN Laing - ditort two • N4INsgottoble-OnlAreuhrethiginal Mae Lung Min RHO BR CatSr Ileathad, aubkona the clatatkaa and Whitt an the date al the BM Pi Ha Vi ol Lan mid ardlidde harsh onittelrel. Ino4q =dams an budSoot rApdha anty when Salad al 'DE ed Lad ' then).
CYttinn leaded end arnd end aria the ago WA lea FePer COhr IOT the We nepatelbn d Moony um( appkabta Oat taddatlart
Eildnatura parlor) Dellusied Elp (Fsdl Slipteltre)
ReSved Bp pug Deft LO-Uolie teen COPY
• 'FlAZARDWARMELAND DroGLIMIEDima Aron ON REVERSE srDE •
for Podurt Contrary $ILLMtflre. traraurn,ar Actwgini
• rEALISHOMTAEC • Dna: tart • eon.4244,1911 SHIPPER'S PlaiMANENT ADDRESS BILL OF LADItE3 CHEVRON PRODUCTS CM:ANY 6001 BOLLINGER CANYON RD. SAN WON, CA 94583 FETNI 25-0527925
dined Marketing
0
MAKE SALE - NORMAL DOCUMFAT NO.: 8S7920 DELIVERY DATE: 46/02/10 11:41 4177 ACCOUNT NO.: 2240017
From:818-347-8670 WEST HILLS HOSPITAL Paoe:12/17 JAN-29-2013 11:08
- rornt. - 'or
SERV FLEET CAR FUELS
TO:. BANTA TERMINAL • 22888 FOB: BANTA TERMINA MONTEBELLO CA 90640 FEIN: 770267495
TRANSFEROR CARAA DLURED FROM MONTEBELLO CA TRM -1001654 F00 OR/OIN FREIGHT COLLECT NKLA BULK TRANSPORT FEIN: 95207Sele PO BOX 31446 BAKERSFIELD CA MOO VIA N/KOLAOS TAW LINES INC
140492 C-1001654-000000-060210-1001654- -00005624700
lprodp43 Desalptbn Srces Oiy Net thy. OAS OIL, CONDUSTIDLE LIOU/D, ON1202. I // 4099.00 GALLONS CALCO ULS SPECIAL DF2 DYED 4099.00 4051.00
• ORM LOADED AT 65 DEGREES F ,NET COMPUTED AT 60 DEGREES F 36.30 API GRAVITY CALIFORNIA DIESEL FUEL. MAXIMUM 15 PPM SULFUR. DYED DIESEL FUEL NONTAXABLE USE ONLY. PENALTY FOR TAXABLE USE. DIESEL FUEL DELIVERED NOT INTENDED FOR MARINE USE. EPA DIESEL REGISTRATION NUMBER 5086 81050
'Weight Big of Wing -Shed Fenn - Orin* Nee Neguileble. Crter Mist Solar* Origlral at Wing with FrelHeld BBL Carden Bstelved,gidgedi 10 du nelevekezed turf We heed on the dale dria awec4@ls Dli ((LSO. and al rain hardnoorannol, Niurfhp warm on Bel heed. Mph% My an &Nord le WM el ant( then).
awe) MCA COPY
War Nu leaded all
Signature (
Rees Ived
end wine Os cargo tank aa proper pont tot on anuantoon ci ylin armory under applieetie MOT rorentat
Delivered By: (Full Stoning)
Darr reg-teddriDleTh
689.19
0.000000 0.00 0.001900 7.51 0.001190 4.70 6150000 509,87 2.000000 163.16 0.001000 3.95
3,950.00000 3,950.00000
3.950.00000
• * *
S132,0 - Ct5
'FelUpto - RAC05 - CDVZPLS - I
JAN-29-2013 11:08 From:818-347-8670
WEST HILLS HOSPITAL Pa9e:13/17
REMIT .*
HflIDIFFUELS P.O. 8OX 81685•13AKERSFIELD, CA 93380-1685
(661) 321-9961
ogai-3,57
Invoice: 824015 Dete: 07/07/10
DueDate:07/27/10 SOL #: 921104
Order #: 48542 Gust PO: 5R16/4000
>7c4of--
BILL TO: 500176-0 GRINANAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
Product Description Quantity Unit Price
23 (ASO CARS #2 DYED 3,950.00000 2.116120 FRU( FREIGHT-DIESEL 3,950.00000 0.00000
SHIP TO: 500176-0 GRIMMWAY ENTERPRISES, INC. P.O. BOX 81498 BAKERSFIELD, CA 93380
Taxes
Deposits Total
689.19 0.00 8,830.93
Total Doe: 8,830.93
PRODUCT TAX SUMMARY Tax Type Base Sty Rate Tax Amount Tax Code Description
0501 State Sales Tax Percentage 0703 Federal Oil Spill - Diesel Per Gallon 0803 Env (011 Spill) - Diesel Per Calton 1203 State Sales Tax DF Percentage 1204 State Sales Tex Other Percentage 2103 Federal LUST - Dieael Per Gallon
Total Taxes . THESE DIESEL PRODUCTS CONTAIN VISIBLE EVIDENCE OF DYE •
i to
Remittance Stub GRIMMWAY ENTERPRISES, 500176-0
INC.
Pay This Amount 8,830.93
Page 1 07/07/10
Invoice: 824015 "•...
29A Nei e
Invoice 824015 Date 07/07/10
DUB Date 07/27/10 ROL # 921104
Order Cust SR16/4000
RILL TO: 500176-0 GRIIRMAY ENTERPRISES. INC. FVE BOX 81498 A
EFIELD. CA 93380
51: TO. 5F1F6-0 9440 EN RPR1SES. INC.
. 81 98 RSF1ELD. CA 93380
JAN-29-2013 11:09 From:818-347-8670
WEST HILLS HOSPITAL Pa9e:14/17
07/09/10 04:15 PM POT Finei_CaTtlFuvis vie VSX-FAX
Page 2 of 2 S9052 BE
,
P.0, BOK MSS BAKERSFIELD, CA 033110-1585 (M) 3214ES1
FLEET CARD FUELS
Product Description Quantity Unit Pricey,/ Taxes Deposits Total
23 I FRTD
UD CARR f2 DYED 3.950.00000 FREIGHT - DIESEL
3.950,00000 :e888 688.19
0,00 8,830,93
Total Due: 8.830.93
Tax Code Description
0501 State Sales Tax Percentage 0703 Federal 011 Spill - Diesel Per Gallon 0803 E5 (0ii Spit) -Diesel ier Gallon
1294 ; g let fax Kay' 1204
ercentage ercentage
2103 Mere LgT - Diesei er Gallon
Total Taxes * MESE DIESEL PRCOUCTS CONTAIN VISIBLE EVIDENCE Cf DYE *
SUMMARY ease QV Rate
0.000000
Tax Anount
0.00 3,950.00000 7.51 3,950.00000
0.00190
° . 00 gigh; 501:19 2.000000 163.16
3.950.00000 0.001000 3.95
689,19
PRODUCT TAX Tax Type
17411819RISES, INC.
07/07/10 invoice: 824015
Pay This Amount 8,830.93
Page 1
JAN-29-2013 11:09 From:818-347-8670
WEST HILLS HOSPITAL Paoe:15/17
0 H6 1145- 2iR Wholesale Fuels Inc ACCOUNTING ormm P.O. Box 82277 Bakersfield, CA 93380-2277
Phone: (68 1) 393-7000 Fax (661) 633-7563
Sold GRIMMBAY ENTERPRISES/MASTER To: ACCOUNTS PAYABLE
P. 0. BOX 81498 BAKERSFIELD, CA 93380-1498
Page: 1
Invoice No: 696613 Invoice Date: 12/07/10 Ship bate' 12/07/10
Profit Center: 1533
Ship GRIMMWAY ENTERPRISES, DOCTOR To: AVENUE M s 60TM ST EAST
LANCASTER, CA
Account No:26630832 PO NO: fielcc Terms: NET 30 DAYS Ship Via:Pacific West Coast Trans Sales ID:12
BOL/Ship.Order:
Product Code/
Quantity Price Description Shipped Each
Extension
B/L Number-- 999618 T: 121 S: 37040296 44 Diese1,3,NA1993,PGIII,Combustible Liquid ## This is dyed Diesel fuel, nontaxable use ## only. Penalty for taxable use. This fuel #4 meets EPA requirement for sulfur, cetane #4 index, or aromatic content.
70 DYED CARD DIESEL
3,795.0 L.A. S/T Dsl\Chg CA Partial Sales TaX Diesel/Y Fed Envrnmntl Fee Dsl/Chg Fed LUST Tax Dsl/Chg CA Oil Spill @.00119/Chg
2.552000 /9,684.84 1.500000%
2.000000% 1.49 1 1 54.
0.001900 3
7.21 (1,TaSN,
TAX (
0.001000 3.80 ;
0.001190 4.52 OK,/
Total Amount: 10,039.89
AMOUNT REF. ACTIVITY
121 - 0 - 0000
10033.51 F g&I KO t 121 ms: 0 2245 - 00001
121 -0 -00001 - 121 -0 00001
121 -00001
TRACO BKSFLD
ORIG. IRRIG S/S FM
I o o CONV IRRIG S/S FM
ORIG. HARVEST CONV. HARVEST
SPILLS OR LEAKS ONLY (42 GALLONS OR MORE) EMERGENCY CONTACT - 1st call PERS 1-800-633-8253
DEC 1 4 2010 I D ACCTS PAYA'd
JAN-29-2013 11:09 From:818-347-8670 WEST HILLS HOSPITAL Pa9e:16'17
( VIOIO Credit Terms: NET DUE 10 DAYS
ULTRA LS DYED DIESEL BULK 120 SOL* 262312 / 3-SJR / 04SJR
CA DYED DIESEL MAXIMUM 15 PPM SULFUR REFERENCE NUMBER: 424793
Bulk Plant (661) 3244728 900 Secremento Street Bakersfield, CA 93305
BILLING ADDRESS
GRIMMWAY FARMS ENTERPRISE MTN: KATHY P.O. BOX 81498 BAKERSFIELD, CA 93380-1498
Pape 1 of 1
REMIT TO PO Box 512
Bakersfield, CA 03302-0512
SHIPPED TO
SR# 16 - LANCASTER SR# 16 - LANCASTER GRIMMWAY FARMS ENTERPRISE LANCASTER, CA 99999
ACCTS PAYABLE AdmInUdratIon Orrice
3200 21st Street Ste.201 Bakerifieid, cA 93301 Phone: (661) 3234644
or (661) 3234021 Fax:(161) 323-2270
INVOICE DATE
12/05109 10:15AM P.O. or M.R.0 BLANKET P.O.
None ACCOUNT*
325000 SHIPTO il
294 "...INVOICE ft
82089 TRUCK*
SPC18
PRODUCT GROSS NET GAL. LB./EA UNIT SIZE KIND CODE DESCRIPTION WY DELIVERED DELIVERED PRICE AMOUNT e
3,700.0000 2.0-4500w $7,588.50 3,700.0000
V 1)(‘ 0.3.1
7042--.1g— 1r.tue, tz 00€5 021,9 5-- (
involce_Taxes Quentltv Amount Duo Exempt LOS ANGELES CO 1.5% 3,700.00 113.55 No
CA-FARMERS SALES TAX 2% 3,700.00 151.40 No LUST-DIESEL .031 3,700.00 3.70 No FED OIL SPILL- DSL .0019 3,700.00 7.03 No
SUB TOTAL $7,558.50
TAXES $275.68
TOTAL / $7,842.18
DUE DATE 12/15/2009
PLEASE PAY FROM THIS INVOICE - NO OTHER STATEMENT WILL BE SENT
Liu TRAM) man oRia woo S/S FM
e) COW. IRRIG S/S FM ORIG. HARVEST CONV. HARVEST
WEST HILLS HOSPITAL Paae:17'17 JAN-29-2013 11:09 From:818-347-8670
SCHWE cm
OFFIOES: a
ETROLEUM COMP • SOLVENTS • CHEMICALS
SIC alCallaaD, CALIFORNIA szia0112 aliTesin; SULK MANZ Fa SACRAMENTO STREET Forms (wn) Basso on (501)2234a21
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REFERENCE alarm
424793 DELIVERY DAM
CUSTOMER ORDER NO.
ND. Ca 1112a PRICE
PRODUCT CODE.
a 0 Pyiemim ' 700 pRonuer CAVE: .---,
'
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PRO UCT COO '
•
- PRODUCr CODE: I
PRODUCT CODE:
FLAMMABLE OR COMBUSTIBLE PROCUCT
• Each charge fOr nnumabla container will he held by • Sala as a &malt (rntahl* with Ito own funds) to secure return merest; will to foratad to saner if
SUB TOTAL
Catidner I. not aurae, Dna ttlagad, within 90 , days altar dere Meech but will he credited tO Buyor,
it it I. ao returns. PREPAID SALES TAX
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BD• ECM PEN . . a , .•:-. .. -nr- ,
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CASH
STATE SALES TAX
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• RECEIVED PAYMENT!
TOTAL AMOUNTDUE WI o'
• DELIVERY MEMO