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BRANCH SSL CSG 22 Jose Moran 05/12/15 <br />13:34 PAGE 1 <br />Safety-Kleen Systems, Inc. <br />2600 N Central Expy, Suite 200 <br />Richardson, TX 75080 <br />CORPORATE: 800-569-5740 <br />24 HR EMERGENCY: 800-468-1760,(Safety-Kleen) <br />2095451011 <br />REFERENCE NBR. <br />CUSTCMER# MC22499 Mcneilus Truck <br />66955536 <br />3100 N Ad Art Rd SRVC <br />WEEK: 2015-20 <br />Attn: Ralph Cortez SRVC DATE: <br />05/12/15 13:34 <br />Stockton CA 95215-2218 <br />PHONE 209-931-4282 <br />BILL TO CUSTOMER# BILL TO ADDRESS: <br />MC22499 Mcneilus Truck <br />3100 N Ad Art Rd <br />Attn: Ralph Cortez <br />Stockton CA 95215-2218 <br />PHONE 209-931-4282 <br />PURCHASE ORDER# <br />TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT QTY UNIT PRICE TAX CHARGE <br />90837 MODEL 90 W/238'7 & 636h 1.000 200.0000 <br />16.00 216.00 <br />S/N 14130323 TAG 00001170SK14130323 CLEAN 3.00 SPENT <br />0.000 <br />SERVICE TERM 12 WEEK Placement SCANNED YES <br />100001 FEE, FUEL SURCHARGE 1.000 11.8200 <br />0.95 12.77 <br />10042 FEE, INSTALL MDL 90,91,94, 216 1.000 0.0000 <br />0.00 0.00 <br />PROMO NBR: l <br />----------------------------------------- <br />TOTAL SERVICE/PRODUCTS 211.8200 <br />16.95 228.77 <br />TOTAL CHARGE <br />228.77 <br />CREDITS <br />0.00 <br />TOTAL DUE <br />--------------- <br />228.77 <br />--------------- <br />UNPAID BALANCE THIS RECEIPT 228.77 <br />Machine clean and good condition? Yes <br />Lamp Assembly Condition Yes <br />Decals in place and legible? Yes <br />Fusible link installed? Yes <br />Emergency closing of lid unobstructed? Yes <br />Machine properly grounded? Yes <br />Local Phone No, Sticker Affixed to Machine Yes <br />Spent solvent meets acceptance criteria? Yes <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 and (ii) no material change has occurred <br />either in the characteristics of the waste/material or in the process <br />generating the waste/material. Customer agrees to pay the above <br />charges and to be bound by the terms and conditions (1) set forth in <br />(a) the General Terms and Conditions provided separately to Customer <br />Page 7 <br />AECEIVE ft� <br />AUG 0 7 2015 <br />ENVIRONMENTAL <br />""_ "-PJ r1C0M17T4ACgIr <br />