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CSG SK-SSL-BOX-23 Raymond Gomez 12/17/19 09:13 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 750BO <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleee) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# N,030843 Moe Auto Repair 81879011-1906590990 <br /> 2255 S Airport Way SRVC WEEK: 2019-51 <br /> Attn: Moe SRVC DATE: 12/17/19 <br /> Stockton CA 95206-3338 <br /> PHONE 209-939-1490 <br /> BILL TO CUSTOMER# BILI, TO ADDRESS: <br /> X030843 Moe Auto Repair <br /> 2255 S Airport Way <br /> Attn: Moe <br /> Stockton CA 95206-3338 <br /> PHONE 209-939-1490 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 1951193/ <br /> 871063 CCS 5GL CHAR SOL/SEMI STA 1.000 195.0000 0.00 195.00 <br /> # CONTS: 1 TSDF: SJ MANIFEST#: 007276741SKS FORM CD: US SHIP€# 230196726 <br /> CNT#: 191210494724 QTY: 20 WT/VOL P PROF# 1951193 SKDOT 8764618 <br /> 83383 DRUM,55 WASTE O.F. 1.000 59.1300 0.00 59.13 <br /> SERVICE TERNS 12 4TEEK <br /> 100030 RECOVERY FEE 1.000 21.6000 0.00 21.60 <br /> 109065 E-Manifest Fee 1.000 20.0000 0.00 20.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 295.7300 0.00 295.73 <br /> TOTAL CHARGE 295.73 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 295.73 <br /> UNPAID BALANCE THIS RECEIPT 295.73 <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 SX agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.58 per month (188 per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> this service Acknowledgement is duly authorized to sign and bind <br /> Customer. Customer acknowledges that it is responsible for maintaining <br />