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CSG SK-SSL-BOX-21 Brandon J Gaither 11/14/17 08:22 PAGE 1 <br /> Safety-Kleen 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# CA39985 Cal West Concrete Cutting 75132978-1705388385 <br /> 1153 Vanderbilt Cir SRVC WEEK: 2017-46 <br /> Manteca CA 95337-6120 SRVC DATE: 11/14/17 <br /> PHONE 209-823-2236 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA39985 Cal West Concrete Cutting <br /> 1153 Vanderbilt Cir <br /> Manteca CA 95337-6120 <br /> PHONE 209-823-2236 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 3383 DRUM,55 GAL FOR O.F. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 24 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 24 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED '.. <br /> 90837 MODEL 90 W/2387 & 6365 1.000 357.0000 29.45 386.45 <br /> SIN 11011266 TAG 00001170SK11011266 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 11.8200 0.98 12.80 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 368.8200 30.43 399.25 <br /> TOTAL CHARGE 399.25 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 399.25 <br /> UNPAID BALANCE THIS RECEIPT 399.25 <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 /> 220-2200 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 /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material, and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions (1) set forth in (a) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> k( <br /> C <br /> Page 5 <br />