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CSG SK-SSL-BOX-23 Raymond Gomez 08/15/18 14:57 PAGE 1 <br /> Safety-KIeen 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;( N,030843 Moe Auto Repair 77486819-1803724053 <br /> 2255 S Airport Way SRVC WEEK: 2018-33 <br /> Attn: Moe SRVC DATE: 08/15/18 <br /> Stockton CA 95206.3338 <br /> PHONE 209-939-1490 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> M030843 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 /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 94837 MODEL 94 W/2387 & 6365 1.000 212.3500 19.11 231.46 <br /> SIN 12000575 TAG 00001260SK12000575 CLEAN 2.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 3383 DRUM,55 GAL FOR O.F. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 83383 DRUM,55 WASTE O.F. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 3101930 22B103X-PP-DR55-VT SAE 10 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 100030 RECOVERY FEE 1.000 19.1100 1.72 20.83 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 1.000 0.0000 0.00 0.00 <br /> 100004 Motor Oil Assessment Fee 1.000 0.0000 0.00 0.00 <br /> 100006 Oil Recycling Fee >70% BASE 1.000 0.0000 0.00 0.00 <br /> ----------------------------- ---------- <br /> TOTAL SERVICE/PRODUCTS 231.4600 20.83 252.29 <br /> TOTAL CHARGE 252.29 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 252.29 <br /> UNPAID BALANCE THIS RECEIPT 252.29 <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 (ii) no material change has occurred <br />