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HKANCH 7142 CS a jafllej, 02/17/11 11:45 PAGE <br /> Safety- leen Systems, Inc. <br /> 5360 Legacy Drive. <br /> Building 2, Suite 100 y <br /> Plano. Texas 75024 <br /> -669-5740 !� <br /> 209-545-1011 <br /> REFERENCE <br /> CUSTOMER! 3083529 itICMERf COPTS- 'flay 531 65 <br /> 120 Frank West Cir SWVC WEEK: 2011- <br /> It <br /> Stockton CA 9S206-4003 SRVC DATE: 02/17/11 11:494 <br /> PHONE 916-825-8269 <br /> PURCHASE ORDERS, 458258 TAX EXEMPTION NN <br /> PRODUCT/SERVICES <br /> SERVICE/ TOT <br /> PRODUCT QTY UNIT PRICE TAX CM <br /> 250101 MODEL 250 W/QSOL 1.000 0.0000 0.00 0.00'® <br /> S/N 6013443 TAG OOIIOSOOS006013441 CLEAN 23.000 SPENT 0.000 1 <br /> SERVICE TERM 16 WEEK SCANNED YES an <br /> CAUSE CODE Clerical -CLERICAL ERROR ON SERIAL NUMBER ENTRY <br /> 100001 FEE, FUEL SURCHARGE 0.000 0.0000 0.00 0. <br /> ...------- <br /> -------------- <br /> TOTAL SERVICE TS 0.0000 0.00 0. <br /> TOTAL CHARGE 0.00' '. <br /> CREDITS 0. "- <br /> TOTAL DUE Q_.__ <br /> .00 <br /> O <br /> UNPAID BALANCE THIS RECEIPT 0.00 -` <br /> C <br /> 69 <br /> Machine clean and good condition? Yes r <br /> LOW 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 16. <br /> - Spent solvent meets acceptance criteria? Yes 10 <br /> GENERATOR STATUS <br /> 0 - 220 lbs/month <br /> i4g;eIveL Customer certifies that (i) the above-nanmd materials are properly <br /> classified, packaged, narked and labeled, and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Departwent of Traniportativn and (ii) no material change has occurred <br /> ry6F (� either in the characteristic of the waste/naterial or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to he bound by the terms and conditions (1) set forth in <br /> (4) the General Terms and Conditions provided separately to Custmner <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> 9 incorporated herein by reference. Unless otherwise indicated in the <br /> 'rflW�h payment received section. SK is authorized to charge Customer's t <br /> ` account for this transaction. Custo,,mr certifies that the individual _ <br /> signing this Service Acknowledgement is duly authorized to sign and <br /> bind Custmuer. The following provision is applicable to Safety-Kleen°s <br /> parts cleaner and paint gun cleaner set-vices: Custmuer agrees that it <br /> will not introduce any substance into the solvent or aqueous cleaning <br /> solution, including without limitation any hazardous waste or <br /> hazardous waste constituent, except to the extent such introduction is <br /> incidental to the normal use of the machine. Customer further agrees r_ <br /> that it will not clean parts/paint guns that have been cuntarninated <br /> with or otherwise introduce polychlorinated biphenyls °s). }t <br /> herbicides, pesticides, dioxins or listed hazardous waste into the O3 <br /> solvent or aqueous cleaning solution. Safety-Kleen has the capacity <br /> and is permitted to accept, store, and/or reclaim the spent parts <br /> washer solvent; paint thinners, solvents and paints generated by sa <br /> customer; or dry cleaning filter cartridge., powder, and still <br /> residues containing perchloroethylene, petrolewo naphtha, or <br /> trifluretrichloroethane dry cleanin,i solvents. Safety-Kleen and <br /> custmuer agree that this agreement is intended to satisfy the <br /> requirements of 40 CFR 262.20(a). IN THE EVENT OF AN EMERGENCY CALL 24 "! <br /> HR f.MFRGFWY r 1-800-46A-1760 (cafsty-Kle.m C,• trwrt a 04138) <br /> CUSTOMER /GENERA :mike <br /> Y <br />