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CSG SK-SSL-BOX-25 Bruce Maeberry 05/22/18 16:01 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 76766031-1802178012 <br /> 2577 W Yosemite Ave SRVC WEEK: 2018-21 <br /> Manteca CA 95337-9641 SRVC DATE: 05/22/18 <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 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 3383 DRUM,55 GAL FOR O.F. 2.000 21.9400 0.00 43.88 <br /> SERVICE TERM 4 WEEK <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 /> 898560 CARTRIDGE OIL FILTERS 55G 2.000 280.9000 0.00 561.80 <br /> SERVICE TERM 4 WEEK <br /> # CONTS: 2 TSDF: WI MANIFEST#: 006520688SKS FORM CD: US SHIP# 225492921 <br /> CNT#: 180515438878 QTY: 100 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> CNT#: 180515438877 QTY: 100 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> 100001 FEE, FUEL SURCHARGE 1.000 12.8100 0.00 12.81 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 2.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 315.6500 0.00 618.49 <br /> TOTAL CHARGE 618.49 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 618.49 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 618.49 <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 (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 /> General Terms and Conditions provided separately to Customer or (b) <br />