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03/27/2018 TUB 16: 12 FAX I®007/024 <br /> CSC; SX-SSirROX-p.4 Raymond Gomez 06/21/16 12:23 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 R EMERGENCYt 500-458-1760 tSafety-Kleer) <br /> 2095451011 <br /> REFERENCE NBR, <br /> CUSTOMER# 8021036 Bobe Lube 6 Smog 70690636 <br /> 1403 Country Club Blvd SRVC WEEXi 2016-21 <br /> Storkton CA 95204-4910 SRVC DATE; 06/27/16 12:21 <br /> PHONE 209-943-3633 <br /> RILL TO CUSTOMER# BILL TO ADDnso: <br /> 8022519 Bobs Lube 6 Smog <br /> 1405 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-941-3631 <br /> PURCHASE ORDER# TAX RXFMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 98800 AQl SERVICE WITH 6365 1.000 297.0500 23.76 320.81 <br /> SIN 90NO011 TAG 000900008KO9030006 CLEAN 1.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL 8 RCHARGE 1.000 9.8600 0.79 10.65 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 306.9100 24.55 331.46 <br /> TOTAL CHARGE 331.46 <br /> CREDITS 0.00 <br /> TOTAL. TAW 1.11 <br /> UNPAIU SALANCS THIS RECEIPT 331.46 <br /> Machine clean and goo Condition? Yen <br /> Lamp A.%aembly Conditi n Yee <br /> Dorals in ple<e and 1 gib1e7 Yea <br /> FUnible link inntallo ? Yrs <br /> Emorgency closing of id unobstructed? Yes <br /> Machine properly grou ded? Yea <br /> Local Phone No. Stick r Affixed to Machine Yea <br /> Spent solvent meets a ceptance criteria? Yes <br /> uUNEWIVR STATUS <br /> 0-220 lba/month <br /> customer certifies th t (il the above-named materials are properly <br /> classified, packaged, marked and labeled, and are in proper condition <br /> for transportation ar. ording to the applicable regulations of the <br /> Department of Transpo tatlon (ii) no material change has occurred <br /> 0ithet In the charact riatica of the waste/materiel or in the process <br /> gonorating the waste/iatorial, and (I1,I) the above rrfcrrnred <br /> Cnneratrr Statue to c rrect. Cuotomor agrso� to pay the abovr nhargr.a <br /> and to be bound by th terms and conditions (1) set forth in (a) t:hn <br /> General Terms and Conitions provided separately to Customer. or. (b) <br /> any SK agreement sign d by Customer and SK, and t2) incorporated <br /> eserein by reference. Ur11eeH ntherwiee inuicdted in the payment <br /> rnnnivod nrctiot1, SK .n nutlhnrizrd to uhatye C116Lomer'e UCCOUnt for <br /> this tranrackinn. If u5tnmar fai..la to makrl paymnnt when due, an <br /> amount equal to the 1 sser of Ill 1.59 per month (106 par, annum) or <br /> (11) the maximum amou t allowed by law, will be added to all unpaid <br /> amounts outstanding, ustomer certifies that the individual signing <br /> this Service Acknowle gement is duly authorized to sign and bind <br /> customer. Customer ae nowledges that it is responsible for maintaining <br /> its Generator Statue nd obtaining an EPA ID number if required by <br />