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�0 <br /> V <br /> SEP 3 0 2016 � <br /> _._ ENVIR®NMEN HEAL' <br /> TAI- . . <br /> DEPART <br /> BRANCH SSL CSG 24 David Buxton 12/04/14 14:13 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 400 <br /> Richardson, 7X 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMERS ST29808 Stockton Rubber Mfg Cc Inc 85135490 <br /> 502' N Flood Rd SRVC WEEK: 2014-49 <br /> Linden CA 95236-9455 SRVC DATE: 12/04/14 14:13. _ <br /> PHONE 209-887-1172 <br /> BILL 70 CUSTOMERS BILL 70 ADDRESS: <br /> ST29808 Stockton Rubber Mfg Cc Inc <br /> 502' N Flood Rd <br /> Linden CA 95235-9455 <br /> PHONE 20-887-1172 <br /> PURCHASE ORDER# TAX EXEMPTS <br /> PRODUCT/SERVICES <br /> SERVICE/ 70TAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 11131 COMS SEC W/CLEAR CHOICE 1.000 288.4400 0.00 298.44 <br /> S/N 13053534 CLEAN 1.000 SPENT 0.000 <br /> SERVICE TERM 8 WEEK <br /> 6814 ACETONE 16 GALLON 1.000 0.0000 0.00 0.00 <br /> SERVICE TERN 24 WEEK <br /> CAUSE CODE VoidHoWerAndLine -SERVICIE NOT NEEDED <br /> 100001 FEE. FUEL SURCHARGE 1.000 15.1300 0.00 15.13 <br /> TOTAL SERVICE/PRODUCTS 313.5700 0.00 313.57 <br /> TOTAL CHARGE 313.57 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 313.57 <br /> UNPAID BALANCE THIS RECEIPT 313.57 <br /> Is the Gua cleaner properly grounded to protect against static electricity?Yes <br /> Is the exhaust gas piping from this Gan Cleaner vented directly outdoors or is <br /> j it wanted into (or located inside) the paint spray booth?Yes <br /> Machine clean and and condition?Yes <br /> Lamp Assembly Co:dltion Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed?Yes <br /> Emergency closing of lid unobstructed?Yes <br /> Machu properly grounded?Yes <br /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS 0 0I <br /> 0-220 lbs/msnth <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 and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/auaterial. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) sot forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SX, mad (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Custamer•s <br /> account for this transaction. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorised to sign and <br /> bind Customer. The following provision is applicmble to Safety-Kleen's <br /> parts cleaner and paint gun cleaner services: Customer agrees that it <br /> will not introduce day substance into the solvent or aqueous-cleaning <br /> selutiaa. i,.rl„d:a. ...hw,.+ 1,...:+.+-0 .. .». <br />