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CSG SK-SSL-BOX-21 David Epstein 07/24/18 12:17 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 77248751-1803216889 <br /> 2577 W Yosemite Ave SRVC WEEK: 2018-29 <br /> Manteca CA 95337-9641 SRVC DATE: 07/24/18 <br /> PHONE 209-249-3204 <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 209-249-3204 <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. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 4 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <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 1.000 300.5600 0.00 300.56 <br /> SERVICE TERM 4 WEEK <br /> # CONTS: 1 TSDF: SJ MANIFEST#: 011837159FLE FORM CD: US SHIP# 225983006 <br /> CNT#: 180623197456 QTY: 200 WT/VOL P PROF# 156777 SKDOT 7612003 <br /> 100030 RECOVERY FEE 1.000 27.8400 2.30 30.14 <br /> 100065 E-Manifest Fee 1.000 10.0000 0.00 10.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 385.8800 6.22 392.10 <br /> TOTAL CHARGE 392.10 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 392.10 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 392.10 <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 /> any SK agreement signed by Customer and SK, and (2) incorporated <br />