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CSG SK-BBL-BOX-24 Bruce Maeberry 12/15/16 14:59 PAGE 1 <br /> Safety-KIeen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORrORAM 800-669-5740 <br /> 24 11R E14ERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NUR. <br /> CUSTOMRR# R02103R Robs Lvhn F, Amng 72251345-1604024724 <br /> 1.403 Country Club R1vd SRVC WEEK: 2016-51 <br /> Stockton CA 95204-4910 SRVC DATE: 12/15/16 14:58 <br /> MNE 209-943-3633 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> 8022519 Bob& Lube 6 Smog <br /> 1403 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-943-3633 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT OTY UNIT PRICE TAX CHARGE <br /> 98800 AQ), SERVICE WITH 6365 1.000 324.2300 25.94 350.17 <br /> BIN 903000 TAO 000980008K0903000fl CLEAN 1.04 SPENT 0.000 <br /> SERVICE TUM 1.2 WEEK SCANNED YES <br /> 100001 FEE, FUEL 8 RCHARGF 1.000 10.1800 0.81 10.99 <br /> ----- ---------------------------------- <br /> TOTAL SER ICE/PRODUCTS 334.4100 26.75 361,16 <br /> TOTAL CHARGE 361.16 <br /> CREDITS 0.00 <br /> ^-- <br /> TOTAL DUE --^^ 361.16 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 361.16 <br /> Machine clean and good condition? Yom <br /> Lamp Assembly Condttt n Yom <br /> Decals in place and 1 q.i.b.le? Yes <br /> rusibie link installs 7 Yea <br /> Emergency closing of lid unobstructedY Yee <br /> Mdt:l,lr,r.. properly grounded? Yea <br /> Loral Picone No. SLicker Affixed to Machine Yes <br /> Spont mn.lv"nt mmete acceptance criteria? Yes <br /> GENERATOR STATUS <br /> D-220 lbs/month <br /> CUmLomer certifies t at (1) the above-named materials are properly <br /> olmnsifiad, packaged, marked and labeled, and are in proper condition <br /> For r.rnnspott.al.lun atcording to the appileable regulations of the <br /> Dnpartmnnt of Trnnspc rtat ion (il) no material change has occurred <br /> either in the characteristic* of thm waste/materiel 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 chargee <br /> anti to be bound by the terms and conditions (1) set forth in (a) the <br /> Ggnr,rml Terms and Co ditions provided separately to Customer or (b) <br /> any SK agreement aig ed by Customer and SK, and (2) incorporatod <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer, fsilm to make payment when due, an <br /> amount equal to the esser of (1) 1,5% por. mohth (18% per annum) or <br /> (li) the maximum amo nt allowed by law, Will he addt•.ti t.0 all unpaid <br /> amounts outstanding. Customer certifies that the indiviriunl signing <br /> this Service Acknowi dgement 1s duly authorized to sign and bind <br /> Cuotomcr., Cuatumer d knowledges that it is responsible for maintaining <br /> It!) fnnerator St:et:ur. and ubl.aining an EPA ID number if required by <br />