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RECE ""17D <br /> JUL 0 9 2018 <br /> CSG SK-SSL-BOX-25 Bruce Maeberry 06/01/18 13:11 PAGE 1 <br /> ENV!RONME`NTAL <br /> Safety-Kleen Systems, Inc. H'EALT'.-; DEPARTMENT <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 600-669-5740 <br /> 24 HE EMERGENCY: 600-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# K1I8372 Kia Country 76972488-1802646950 <br /> 1515 N Main St SRVC WEEK: 2016-22 <br /> Manteca CA 95336-3243 SRVC DATE: 06/01/18 <br /> PHONE 999-999-9999 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> KI18372 His 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 /> 3383 DRUM,55 GAL FOR O.F. 1.000 5.0000 0.00 5.00 <br /> SERVICE TERM 12 WEEK <br /> 83383 DRUM,55 WASTE O.F. 2.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidLine -WASTE PICKUP ONLY <br /> 898560 CARTRIDGE OIL FILTERS 55G 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 1247494/ <br /> 875000 FB1-LQD FOR FUEL 55GL 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VcidHeaderAndLine -SERVICE NOT NEEDED <br /> 944502/ <br /> 875460 CNO-NON HAZARDOUS SOLID 5 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 944505/ <br /> 871063 CCS 5GL CHAR SOL/SEMI STA 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidLine -WASTE PICKUP ONLY <br /> # CONTS: 1 TSDF: SS MANIFEST#: 006520910SKS FORM CD: US SHIP# 225562615 <br /> CUT#: 180524609051 QTY: 10 WT/VOL P PROF# 944505 SKDOT 7572225 <br /> 1655744/ <br /> 875482 CNOS 15GL NON RAZ SEMI SL 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 90837 MODEL 90 W/2387 6 6365 1.000 109.0000 8.99 117.99 <br /> SIN 13130188 TAG 00001170SK13130188 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br /> 3230 TAX HANDLING HID DRUM DROP 30 1.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 114.0000 8.99 122.99 <br /> TOTAL CHARGE 122.99 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 122.99 <br /> UNPAID BALANCE THIS RECEIPT 122.99 <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 />