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JUL <br /> CSG SK-SSL-BOX-21 Wilmer Garcia Garcia 05/25/18 08:10 PAGE 1 ENMIROWANTAL <br /> IEALTF,QEpFr�TMENT <br /> Safety-KIeen 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# KI18372 Kia Country 76973973 <br /> 1515 N Main St SRVC WEEK: 2018-21 <br /> Manteca CA 95336-3243 SRVC DATE: 05/25/18 <br /> PHONE 999-999-9999 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> KI18372 Kia Country <br /> 1515 N Main St <br /> Manteca CA 95336-3243 <br /> PHONE 999-999-9999 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 0.0000 0.00 0.00 <br /> RETURNS/EXCHANGES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 3345 DRUM, 30 GL BLACK STEEL 0 1.000 -49.0000 -4.04 -53.04 <br /> CAUSE CODE Return -UNAUTHORIZED PURCHASE <br /> TOTAL RETURNS/CREDITS -49.0000 4.04 -57.08 <br /> TOTAL CHARGE 0.00 <br /> CREDITS -53.04 <br /> --------------- <br /> TOTAL DUE -53.04 <br /> -------------- <br /> UNPAID BALANCE THIS RECEIPT 0.00 <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 /> amounts outstanding. Customer certifies that the individual signing <br />