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CSG SK-SSL-UMO-01 Joseph R Lima Jr 07/17/17 10:17 PAGE 1 <br />Safety-Kleen Systems, Inc. <br />2600 N Central Espy, Suite 200 <br />Richardson, TX 75080 <br />CORPORATE: 800-669-5740 <br />24 MR EMERGENCY: 800-468-1760 (Safety-Kleen) <br />2095451011 <br />REFERENCE NBR. <br />CUSTOMER# K118372 Kia Country 74086293-1703212680 <br />1515 N Main St SRVC WEEK: 2017-29 <br />Manteca CA 95336-3243 SRVC DATE: 07/17/17 <br />PHONE 209-239-6203 <br />BILL TO CUSTOMER# 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# 8923 TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ TOTAL <br />PRODUCT QTY UNIT PRICE TAX CHARGE <br />66636 USED OIL RECYCLE CRANKCAS 355.000 0.0000 0.00 0.00 <br />SERVICE TERM 4 WEEK <br />HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br />10256 FEE, OIL SERVICE/STOP NON 1.000 80..0000 0.00 80.00 <br />SERVICE TERM 4 WEEK <br />----------------------------------------" <br />TOTAL SERVICE/PRODUCTS 80.0000 0.00 60.00 <br />TOTAL CHARGE 80.00 <br />CREDITS 0.00 <br />--------------- <br />TOTAL DUE 80.00 <br />UNPAID BALANCE THIS RECEIPT 80.00 <br />If high risk source, rep. certifies that load specific PCB & Silicon <br />testing have been completed prior to pumping this load. <br />GENERATOR STATUS <br />CESQG: Vehicle <br />Customer certifies that (1) 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 teras and conditions (1) at 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 (1) 1.5# per month (188 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 />this Service Acknowledgement is duly authorized to sign and bind <br />Customer. Customer acknowledges that it is responsible for maintaining <br />its Generator Status and obtaining an EPA ID number if required by <br />