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CSG SK -SSL -BOX -21 Brandon J Gaither 01/21/16 12:22 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 NBR. <br />CUSTOMER# KI18372 Kia Country 69315532 <br />1515 N Main St SRVC WEEK: 2016-4 <br />Manteca CA 95336-3243 SRVC DATE: 01/21/16 12:21 <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# 77234 TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT <br />QTY UNIT <br />PRICE <br />TAX <br />CHARGE <br />944507/ <br />875121 <br />LCCRQ-LP AEROSOLS FOR INC <br />1.000 <br />205.0000 <br />0.00 <br />205.00 <br />SERVICE TERM 8 WEEK <br />CHANGE TERM 12 WEEK <br /># CONTS: <br />1 TSDF: SJ MANIFEST#: <br />91230 <br />FORM CD: BL <br />SHIP# <br />218266680 <br />CNT#: 150821721162 QTY: 25 <br />WT/VOL P <br />PROF# 944507 <br />SKDOT 7572211 <br />944502/ <br />875461 <br />CNO-NON HAZARDOUS SOLID 3 <br />1.000 <br />165.0000 <br />0.00 <br />165.00 <br />SERVICE TERM 8 WEEK <br />CHANGE TERM 12 WEEK <br /># CONTS: <br />1 TSDF: SJ MANIFEST#: <br />005244664SKS <br />FORM CD: US <br />SHIP# <br />218266694 <br />CNT#: 160120475728 QTY: 30 <br />WT/VOL P <br />PROF# 944502 <br />SKDOT 7572224 <br />944505/ <br />871063 <br />CCS -CHAR SOL/SEMI STABLZ <br />1.000 <br />75.0000 <br />0.00 <br />75.00 <br />SERVICE TERM B WEEK <br />CHANGE TERM 12 WEEK <br /># CONTS: <br />1 TSDF: SJ MANIFEST#: <br />005244664SKS <br />FORM CD: US <br />SHIP# <br />218266694 <br />CNT#: 160120475725 QTY: 30 <br />WT/VOL P <br />PROF# 944505 <br />SHOOT 7572225 <br />3324 <br />DRUM, 16 GL BLACK STEEL 0 <br />1.000 <br />41.7300 <br />3.55 <br />45.28 <br />SERVICE TERM 12 WEEK <br />3345 <br />DRUM, 30 GL BLACK STEEL 0 <br />2.000 <br />49.0000 <br />8.33 <br />106.33 <br />SERVICE TERM 12 WEEK <br />TOTAL SERVICE/PRODUCTS <br />----------------------------------------- <br />535.7300 <br />11.88 <br />596.61 <br />TOTAL CHARGE 596.61 <br />CREDITS 0.00 <br />-------------- <br />TOTAL DUE 596.61 <br />UNPAID BALANCE THIS RECEIPT 596.61 <br />GENERATOR STATUS <br />0-220 lbs/month <br />