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03/27/2018 TUE 16: 22 PAX U020/025 <br /> CSG SK-SSL-BOX-23 Raymond Gomez 11/21/17 11:29 PAGE I <br /> afety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richard.-ion, TX 75080 <br /> CORPORATR: 800-669-5740 <br /> 7.4 IR FMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMERM 8021036 soba Lube 6 Smog 75195014-1705532737 <br /> 1403 Country Club Blvd SRVC WFFK: 201.7-47 <br /> Stockton CA 95204-4910 ERVC DATE: 11/21/17 <br /> PHONE 209-943-3633 <br /> BILL TO CUSTOMERN BILL TO ADDRESS: <br /> 8022519 Bobs Lube s Smog <br /> 1403 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-943-3633 <br /> PURCHASE ORDER0 TAX EXEMl7'M <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PkODUCT QTY UNIT PRICE TAX CHARGE <br /> 98800 A01 SERVICE WITH 6365 1.000 324,2300 25.13 349.36 <br /> SIN 10M(30 TAS G00900008K09030008 CLEAN 1,00 SPFNT 0.000 <br /> SF.RVICR TR 4 17 WFFK SCANNSD YE8 <br /> 100001 FFF, FURL S(RCHARGE 1.000 11,8200 0.92 12.74 <br /> ----------------------------------------- <br /> TOTAL SEK ICE/PRODUCTS 316.0500 z6.o5 362.10 <br /> TOTAL CHARGE 362,10 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 362.10 <br /> --------------- <br /> IINPATD RALANCR HTS RFCFTPT 362.10 <br /> Machine clean and good condition? Yea <br /> Lamp Assembly CondiLio Yes <br /> Decals In place and le ible? Yes <br /> Fusible link inat,alled Yes <br /> Emergency closing of 1 d unobstructed? Yea <br /> Machine properly groun ed? Yee <br /> Local Phone No. Stieke Affixed to Machine Yes <br /> Spent aolvent meet! ac eptance criteria'? Yea <br /> G*19RATOR STATUS <br /> 0-770 lbn./month <br /> Customer certifies tha li) the above-named materials are properly <br /> claasitied, packaged, ;ked and labeled, and are In peuper cundlLiun <br /> ror transportation acc rding to the applicable. reyulatAona of hhr. <br /> Department: of Transport t.10h (ii.) no material change hair or..curred <br /> either in the characle• Rtirs of the waste/material or in the process <br /> generating the waste/ma erial, and (iii) the above referenced <br /> GeneratorStatus is cor act. Customer agrees to pay the above charges <br /> and to be bound by the arms and conditions (1) set forth in (a) the <br /> General Terms and Condi ions provided separately to Customer or Ib) <br /> any SK agreement signed by Customer and 3K, and (2) incorporated <br /> herein by reference, U less otherwise indicated in the payment <br /> received aec[ion, SK is authorized to charge Custnmrr'a aCCOUnt for <br /> Lhis L'rnnsscLiun. If Cu tumal- railK to make payment when duo, an <br /> amount equal. I:o lhr. 1rm rr or (1) 1,5q per, monhh (IRI par nnmlm) or <br /> (ii) r.hn maximum amountallowed by law, will be added to all unpaid <br /> amounts outstanding. Cu tuner certifies that the individual signinq <br /> this Service Acknowledq meet is duly authorized to sign and bind <br /> Customer. Customer ackn wledges that it is responsible for maintaining <br />