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CSG SK-SSL-BOX-25 Bruce Maeberry 07/05/17 11:38 PAGE 1 <br /> Safety-Kleen 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 NSR. <br /> CUSTOMER# KI18372 His Country 74105413-1703241837 <br /> 1515 N Main St SRVC WEEK: 2017-27 <br /> Manteca CA 95336-3243 SRVC DATE: 07/05/17 <br /> PHONE 209-239-6203 <br /> BILL TO COSTOMER# BILL TO ADDRESS: <br /> KI18372 Kia Country <br /> 1515 N Main St <br /> Manteca CA 95336-3243 <br /> PHONE 209-239-6203 <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. 3.000 10.0000 0.00 30.00 <br /> SERVICE TERM 24 WEEK <br /> 898560 CARTRIDGE OIL FILTERS 55G 1..000 150.0000 0.00 150.00 <br /> SERVICE TERM 8 WEEK <br /> # CONTS: 1 TSDF: WI MANIFEST#: 006100902SKS FORM CD: US SNIP# 222830989 <br /> CNT#: 170610656863 QTY: 100 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> 83383 DRUM,55 WASTE O.F. 2.000 25.0000 0.00 50.00 <br /> SERVICE TERM 24 WEEK <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 N/C DRUM DROP 30 3.000 0.0000 0.00 0.00 <br /> ------------------- --------------------- <br /> TOTAL SERVICE/PRODUCTS 294.0000 8.99 347.99 <br /> TOTAL CHARGE 347.99 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 347.99 <br /> UNPAID BALANCE THIS RECEIPT 347.99 <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 /> 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 (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 />