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CSG SK-SSL-BOX-21 Brandon J Gaither 11/06/17 10:26 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 75071484-1705248447 <br /> 2577 W Yosemite Ave SRVC WEEK: 2017-45 <br /> Manteca CA 95337-9641 SRVC DATE: 11/06/17 <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. 1.000 108.1600 0.00 108.16 <br /> SERVICE TERM 4 WEEK <br /> 3383 DRUM,55 GAL FOR O.F. 2.000 20.6000 0.00 41.20 <br /> SERVICE TERM 4 WEEK <br /> 8003369 DRUM, 55 GL BLACK STEEL 0 1.000 47.4800 3.92 51.40 <br /> SERVICE TERM 4 WEEK <br /> 898560 CARTRIDGE OIL FILTERS 55G 1.000 265.0000 0.00 265.00 <br /> SERVICE TERM 4 WEEK <br /> # CONTS: 1 TSDF: WI MANIFEST#: 006193406SKS FORM CD: US SHIP# 223900129 <br /> CNT#: 171031575994 QTY: 150 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> 814374/ <br /> 875120 LCCRQ 55GL LP AEROSOLS FO 1.000 372.8400 0.00 372.84 <br /> SERVICE TERM 4 WEEK <br /> # CONTS: 1 TSDF: WI MANIFEST#: 63935 FORM CD: BL SHIP# 223900134 <br /> CNT#: 171103631131 QTY: 125 WT/VOL P PROF# 814374 SKDOT 7481696 <br /> 100001 FEE, FUEL SURCHARGE 1.000 11.8200 0.98 12.80 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 2.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 825.9000 4.90 851.40 <br /> TOTAL CHARGE 851.40 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 851.40 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 851.40 <br /> GENERATOR STATUS <br /> 220-2200 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 (ii) no material change has occurred <br /> either in the characteristics of the waste/material 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 charges <br /> and to be bound by the terms and conditions (1) set forth in (a) the <br />