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RECEIVED <br /> SEP 3 0 2016 <br /> �...�_. �.,M .F. w ._..-..w <br /> ENVIRONMENTAL HEAL? <br /> DEPARTMENT <br /> BRANCH SSL CSG 24 David Buxton 08/11/14 15:38 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Ceoral Expy, Suite 400 <br /> Richardson, TX 7saso <br /> CORPWATF.AAO-669-1740 <br /> 24 HR EMERGENCY: 800-.4684760 (Srfety-81ee01l <br /> .20lS451011 -_ <br /> REFERENCE NBR. <br /> CUSTOMER# ST29804 Stockton Rubber Mfg Ca Inc 64245143 <br /> 5023 N Flood Rd SRVC WEEK: a014-33 <br /> Linden .CA 95236-94S5 SRVC DATE: 08/11/14 15:38 <br /> PHONE 209-88771172 <br /> BILL TO CUS110MENO BILL TO ADDRESS:', <br /> ST20808 Stockton Rubber Mfg Co Inc .* <br /> 5023 N Flood Rd <br /> Linden CA 95236-9455 <br /> PHONE 209-887-1172 <br /> PURCHASE ORDER* TAX EXEMPT# <br /> PRODUCT/SERV)ECES <br /> SERVICE/ - 10TAL <br /> PRODUCT q7t W 6pWE TAX 'CHARGE <br /> -t <br /> 13331 COMS SEC W/CLEAR CHOICE L:0049.' •= 298.4400 0.00 298.44 <br /> S/N 13053534 CLEAN 1.000 SPENT 0.000 <br /> SERVICE TERM 8 WEEK <br /> 729218/ <br /> 876220 NODI PCB 9ALLA5lS<SOPPM RE 0.06 0.0000 0.00 0.00 <br /> SERVICE TER1414 WEEK <br /> CAUSE CODE VoidReaderAndLine -SERVICE NOT NEEDED <br /> 100001 FEE, FUEL SURCHARGE 1.000 16.1200 0.00 16.12 <br /> --------------- ------------------------ <br /> TOTAL SERVICE/PROOUCTS 314.5600 0.00 314.56 <br /> TOTAL CHARGE 314.56 <br /> CREOIIS 0.00 <br /> --------------- <br /> 19TAL DUE 314.56 <br /> UNPAID BALANCE THIS RECEIPT 314.56 <br /> Is the Gen cleaner properly grunad:,t to protect aya'inst static electricity? Yes <br /> Is the exhaust gas piping from this Gun Cleaner vented.directly outdoors or is <br /> it vented into (or located inside)..the paint.spray booth? Yes <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 unobstructad't',Yei <br /> Machine properly groundedT'Yes <br /> Local Phone No. StickerAffixed to Machine Yes <br /> Spent solvent meets acceptanca criteria?Yes" <br /> GENERAIM STATUS <br /> 0-220 lbs/month <br /> Costumer certifies that (i) the above-warned oraterials are properly <br /> classified, packaged, marked a" labeled, and are'in proper condition <br /> for transportation according to theapplicable regulations of the <br /> Departorent of Transportation and Ciii no tnaterial charge has occurred <br /> either in the characteristics of the Waste/ivater'ial or in the process <br /> generating the Waste%rwterial. Custemer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Custaner <br /> 11' (h) any SK agreement signed by Customer and SK, and (2) <br /> ncarporatad herein by reference. Unless utherwise indicated in the <br /> Payment received section. SK is authorised to charge Customer's <br /> account for this transaction. Custuxaer certifies that the individual <br /> signing this Service Acknawledgevrent is duly aathoriaed to sign and <br /> bind Custarner. The followinu <br />