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CSG SK-SSL-VAC-42 Henjaniin D Taylor 01/10/18 13:05 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Espy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> Z4 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> CUSTOMER# ]69793 IS Hunt - Stoca REFERENCE NBR. <br /> 2660 Loomis Rd 75SRVC WEEK. <br /> 2 19989 <br /> Stockton CA 95205-0000 SRVC WEEK: 211813 <br /> SRVC GATE: 01/10/18 <br /> PHONE 209-235-1365 <br /> HILL TO CUSTOMER# HILL TO ADDRESS: _ <br /> 104788 19 Hunt <br /> 705 8 North Bloomington <br /> Lowell AR 72745-0000 <br /> PURCHASE ORDER# <br /> PHONE 479-659-SSOS <br /> ' <br /> PRODUCT/SERVICES TAX EXEMPT# <br /> . SERVICE/ <br /> PRODUCT TOTAL <br /> 66667 yACUUM LIQUID QTY UNIT PRICE TAX CHARGE <br /> (NDN-PQUAL) 455.000 1.2600 0.00 573.30 <br /> SERVICE TLRM 24 WEEK <br /> HALOGEN / CLOR-O-TECT TEST RESULT PASS: ppM < 1000 <br /> VAC PH TE,T: 8 <br /> # CONTS: 1 TSOF: EvG MANIFESTO: 13331 FORM CO: BL SHIP# 224439916 <br /> CNT#: 180108917149 QTY: 1300 WT/VOL G PROF# 156097 SK00T 3299 <br /> 66677 VACUUM SOL Fn (NnN-pQUAL) 845.000 1.7500 0.00 13299 <br /> SERVICE T -... 14 .:EEK <br /> 478.75 <br /> HALD6IN , ..-u16 '-FtCT TEST RESULT PASS: ppM < 1gO0 <br /> VAC PH TE,f: 8 <br /> # CONTS: I 'MOF: EVC MAh�FEST#: 13331 FORM CO., BL SHIP# 224439916 <br /> CNT#: 180108917150 QTY: 1300 WT/VOL G PROF# 156097 <br /> 10967 VAC SERVIC' 9 <br /> SK64T 329_ FEE AUTOMOTIV 1.000 O.000q 0.00 09 <br /> 10134 TECHNICAL ..ABOR CHARGE 4.000 96.OM 0.00 384 _ <br /> SERVICE 7_RM 24 WEEK .00 <br /> 10913 VAC TRUCK HASH 1,000 300.0000 0.00 300.00 r' <br /> 10924 FEE. VAC X-EEN DRAIN SHV 3.00p I40.00Op <br /> 82116 420. <br /> HALOGENS TEST 1.000 120.0000 0.00 120.00 <br /> 10977 FEE, VAC 7-1% SOLIDS 1300,000 0.0000 D.Op D.00 <br /> 10904 VAC SVS SEIIVIC£FEE 4 1.000 347.0400 0.00 <br /> 347.00 <br /> 7DTAL SE1iV.FCE ---••----`-------•--- <br /> /PR000CTS 1006.9100 0.00 3623.05 <br /> TOTAL CHARGE 3623.05 <br /> CREDIT 0.00 <br /> TOTAL DUE -----•3623.05 <br /> UNPAID SALANC" THIS RECEIPT 3623.05 -� <br /> Per BOG M470-001 the halogen detecting instrument has been <br /> zeroed and validated. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <br /> Customer certifies tint <br /> classified. packaged, ma(i) the above-named materials are properly <br /> rked and labeled. and are in proper condition <br /> for transportation a xording to the applicable regulations of the <br /> Department of Transplrtation fii) no material change has occurred <br /> \ either in the characteristics of the waste/material or in the process <br /> generating the wastOlmatarial, and (iii) the above referenced <br /> Generator Status is _orrect. Customer agrees to pay the above charges <br /> and to be bound by tye terms and conditions (I) set forth in (a) the <br /> General Terms and Coiditions Provided separately et Customer or (b) <br /> any SK agreement siuted by Customer and SK, and (2) incorporated <br /> r herein by reference. Unless Otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account fur <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.S% per month (la% per annum) or <br /> (ii) the maximum amglnt allowed by law, will be added to all unpaid <br /> amounts outstandin0- Customer certifies that the individual sioninn <br />