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CSG SK-SSL-BOX-21 Brandon J Gaither 02/02/16 08:53 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 69214432 <br /> 2577 W Yosemite Ave SRVC WEEK: 2016-6 <br /> Manteca CA 95337-9641 SRVC DATE: 02/02/16 08:50 <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 /> 90837 MODEL 90 W/2387 & 6365 1.000 251.6400 21.39 273.03 <br /> S/N 13130315 TAG 00001170SK13130315 CLEAN 3.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 8003369 DRUM, 55 GL BLACK STEEL 0 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <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 /> 100001 FEE, FUEL SURCHARGE 1.000 9.2200 0.78 10.00 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 2.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 385.8600 22.17 533.03 <br /> TOTAL CHARGE 533.03 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 533.03 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 533.03 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine properly grounded? Yes <br /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <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 />