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CSG SK-SSL-BOX-21 Brandon J Gaither 01/15/16 10:13 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# GA15065 Gardner Trucking/Classic Sales In 69048834 <br /> 2577 W Yosemite Ave SRVC WEEK: 2016-3 <br /> Manteca CA 95337-9641 SRVC DATE: 01/15/16 10:12 <br /> PHONE 785-690-0109 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> GA15065 Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> Manteca CA 95337-9641 <br /> PHONE 785-690-0109 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 83383 DRUM,55 WASTE O.F. 2.000 105.0000 0.00 210.00 <br /> SERVICE TERM 2 WEEK <br /> 3383 DRUM,55 GAL FOR O.F. 2.000 20.0000 0.00 40.00 <br /> SERVICE TERM 2 WEEK <br /> 650034 ANTIFREEZE, PEAK FLEET CH 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 814374/ <br /> 875120 LCCRQ-LP AEROSOLS FOR INC 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 100001 FEE, FUEL SURCHARGE 1.000 9.8600 0.00 9.86 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 2.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 134.8600 0.00 259.86 <br /> TOTAL CHARGE 259.86 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 259.86 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 259.86 <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that (i) the above-named materials are properly <br /> classified, packaged, marked and labeled, and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Department of Transportation and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. If Customer fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.5% per month (18% per <br /> annum) or (ii) the maximum amount allowed by law, will be added to all <br />