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V�/ c It cV iV lwr -Wi t7 ctsn IjwvV ,?/ V c.t <br /> 3J <br /> CSG SK-SSL-BOX-23 R7ymond Gomm 09/22/16 lit PAGE 1 <br /> Safety-Meen Systems, Inc. <br /> 260n N Central Expy, Suite 200 <br /> Richardson, TX 75000 <br /> CORPORATE; 800-669-5740 <br /> 24 iR EMERGENCY: 800-468-1760 (8afety-Kleen) <br /> 2095451011 <br /> REPERENCL NBR. <br /> CUSTOMER# 8021038 Bobs Lube 6 Emog 71471385.1602976642 <br /> 1403 country club Blvd SRVC WEEK: 2016-39 <br /> Storktoit CA 95204-4910 SRVC DATE: 09/22/16 11:00 <br /> PHONE 209-943-3633 <br /> BTL1. TO CLIBTOMFR# RTid, TO ADDRESS: <br /> 8022519 Bobs Lube j 8moq <br /> 1403 country club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-943-3633 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 95 <br /> 96800 AQ1 SERVICE WITH 6365 11000 305.9200 24,47 330.39 <br /> SIN 9030001 TAG 000900002WO9030008 CLEAN 1.00 SPENT 0.000 <br /> SERVICE TEU4 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL A RCHARGE 1.000 9.8600 0.49 10.6b <br /> -------- ----- <br /> TOTAL SFR TCF/PRODUCTS 315,7800 25.26 341.04 <br /> TOTAL CHARGE 341.04 <br /> CREDITS 0100 <br /> TOTAL DUE -------341.04 <br /> --------------- <br /> UNPAID BALANCE 'PHIS RECEIPT 341,04 <br /> Machine clean and gool condition'P Yea <br /> Lamp Aaaembly Conditl n Yea <br /> Decals in plate and 1 gible? Yes <br /> rltsiblc link insi:alle ? Yes <br /> Lemergency closing of I Id unobstrur..tnd? Yon <br /> Machine properly grou ded? Yes <br /> Local Phone No. Stick r Affixed to Machine Yes <br /> Spent solvent meets a ceptance criteria? Yes <br /> GENEKATUR STA'1'U8 <br /> 0-220 lba/month <br /> Customer certifies that (i) the above-named materials arc properly <br /> classified, packaged, marked and labeled, and are to propnr nondli.ion <br /> for transportation ac ording to the applicable requlat.ions of thn <br /> Dopti tmertt of Transportation (ii) no material change has occurred <br /> rithrr lit the chdtdLL ristlos or the waste/material or in the process <br /> genoroting tho wantn/ oter.lal, and fill) the above rererellaed <br /> Generator Status is c rrncat, C4Rtmmor sgrnr..N to pny I:he above charges <br /> and to be bound by t.h terms and conditions (l.) sot forth in (a) the <br /> General Terms and con ltlons provided separately to Custwtar or (b) <br /> dny SK agreement sign id by customer and sx, and (2) incorporated <br /> hnrr.in by rmfereue.e. Unleas otherwise Indicated in the payment <br /> r.er,.oivod Sit n authorized to charge customer's account for <br /> this transaction. If 3ustomer fails to make payment when due, an <br /> amount equal to the 1 ssrr of (i) 1,51 per month (loo per annum) or <br /> (ii) the maximum amou t allowed by law, will be added to all unpaid <br /> amounts outstanding. ustomer certifies that the individual signing <br /> teiis Service Acknowle gement is duly authorized to sign anti bled <br /> Customer. customer acknowledges that it is responsiblo for mnlnr.nlniny <br />