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CSG SK -SSL -BOX -21 Brandon S Gaither 12/19/17 10:50 PAGE 1 <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# KII8372 Kia Country 75431573-1706011820 <br />1515 N Main St SRVC WEEK: 2017-51 <br />Manteca CA 95336-3243 SRVC DATE: 12/19/17 <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# TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ TOTAL <br />PRODUCT QTY UNIT PRICE TAX CHARGE <br />B3383 DRUM,55 WASTE O.F. 2.000 25.0000 0.00 50.00 <br />SERVICE TERM 12 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 />3383 DRUM,55 GAL FOR O.F. 2.000 10.0000 0.00 20.00 <br />SERVICE TERM 12 WEEK <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 />100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br />3230 TAX HANDLING N/C DRUM DROP 30 2.000 0.0000 0.00 0.00 <br />------------- --------------------------- <br />TOTAL SERVICE/PRODUCTS 144.0000 8.99 187.99 <br />TOTAL CHARGE 187.99 <br />CREDITS 0.00 <br />--------------- <br />TOTAL DUE 187.99 <br />UNPAID BALANCE THIS RECEIPT 187.99 <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 />220-2200 lb9/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 />