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CSG SK -SSL -BOX -23 Wilmer Garcia Garcia 09/21/17 <br />11:31 <br />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: 800-46B-1760 (Safety-Kleen) <br />2095451011 <br />REFERENCE NBR. <br />CUSTOMER4 <br />KI1B372 Kia Country 74706135-1704477954 <br />1515 N Main St SRVC WEEK: <br />2017-39 <br />Manteca CA 95336-3243 SRVC DATE: <br />09/27/17 <br />PHONE 209-239-6203 <br />BILL TO CUSTOMER* BILL TO ADDRESS: <br />KI18372 <br />Kia Country <br />1515 N Main St <br />Manteca CA 95336-3243 <br />PHONE 209-239-6203 <br />PURCHASE ORDER* 81412 <br />TAX EXEMPT* <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT <br />QTY UNIT PRICE TAX CHARGE <br />83383 <br />DRUM,55 WASTE O.F. 2.000 25.0000 <br />0.00 <br />50.00 <br />SERVICE TERM 12 WEEK <br />90837 <br />MODEL 90 W/2387 6 6365 1.000 109.0000 <br />8.99 <br />117.99 <br />SIN 13130188 TAG 00001170SK13130188 CLEAN 2.500 SPENT <br />0.000 <br />SERVICE TERM 12 WEEK SCANNED YES <br />3383 <br />DRUM,55 GAL FOR O.F. 2.000 10.0000 <br />0.00 <br />20.00 <br />SERVICE TERM 12 WEEK <br />898560 <br />CARTRIDGE OIL FILTERS 55G 1.000 0.0000 <br />0.00 <br />0.00 <br />SERVICE TERM 12 WEEK <br />CAUSE CODE VOidHeaderAndLine -SERVICE NOT NEEDED <br />100001 <br />FEE, FUEL SURCHARGE 1.000 0.0000 <br />0.00 <br />0.00 <br />3230 <br />TAX HANDLING HIT DRUM DROP 30 2.000 0.0000 <br />0.00 <br />0.00 <br />------------------------------------- <br />TOTAL SERVICE/PRODUCTS 144.0000 <br />8.99 <br />____ <br />187.99 <br />TOTAL CHARGE <br />187.99 <br />CREDITS <br />0.00 <br />TOTAL DUE <br />_______________ <br />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 />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 />