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' CSG SK-SSL-UMC-01 Joseph R Lima ]r 01/24/19 11:55 PAGE 1 <br /> I 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 /> 79083182-1900422395 <br /> CUSTOMER* 5027286 4101hSaAirport AWAY ion SRVC WEEK: 2019-4 <br /> Stockton CA 95206-3909 SRVC DATE: 01/24/19 <br /> PHONE 209-261-1706 <br /> ( BILL TO CUSTOMER# BILL TO ADDRESS: <br /> 5027286 Southbay Auto Auction <br /> 4101 S Airport Way <br /> Stockton CA 95206-3909 <br /> PHONE 209-263-1706 TAX EXEMPT# <br /> PURCHASE ORDER# <br /> PRODUCT/SERVICES <br /> TOTAL <br /> SERVICE/ TAX CHARGE <br /> PRODUCT Rn' UNIT PRICE 3S.00 <br /> 661336 USED OIL RECYCLE AU <br /> TOMOTI 25.000 1.400D 0.00 <br /> SERVICE TERM 12 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> 10256 FEE, OIL SERVICE/STOP NON 1.000 145.0000 0.00 145.00 <br /> SERVICE TERM 12 WEEK <br /> 9 66665 ANTIFREEZE (NON-PRFQUAL) 40.000 1.0700 0.00 42.SO <br /> SERVICE TERM 52 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: FPM < 1000 <br /> _-- --------------- <br /> TOTAL SERVICE/PRODUCTS ----- 147.4700 0.00 222.80 <br /> TOTAL CHARGE 222.80 <br /> ■ CREDITS 0.00 <br /> TOTAL DUE --__---222.80 <br /> UNPAID BALANCE THIS RECEIPT <br /> 222.80 <br /> If high risk source, rep. certifies that load specific PCB & Silicon <br /> testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <br /> Customer certifies that (i) the above-named materials are properly <br /> aged, marked <br /> classified, pack 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 /> above charges <br /> Generator Status is correct. Customer agrees to set forth in (c the <br /> and to be bound by the terms and conditions (1)separately et Customer or (b) <br /> General Terms and Conditions provided and (2) incorporated <br /> any SK agreement signed by Customer and SK, <br /> herein by reference. Unless otherwise indicated in the payment <br /> SK is authorized to charge Customer's <br /> account for <br /> received section, payment <br /> due, An <br /> this transaction. <br /> If Customer (i) 1.5% per s to emon h (1896 per annum) or <br /> amount equal to the lesser of (i)d by law, will be added to all unpaid <br /> (ii) the maximum amount alloyecertifies that the individual signing <br /> amounts outstanding. Customer <br /> tis duly authorized to sign and bind <br /> his Service Acknowledgement <br /> Customer. Customer acknowledges that it is responsible for maintaining <br /> its Generator Status and obtaining an EPA TO number if required by <br /> applicable law. The following provision is applicable to <br /> Safety-Kleen's parts cleaner and paint gun cleaner services: Customer <br /> .h.t it will not introduce any substance into the solvent or <br /> ...:al ..r 14m4r,.r4nn env hazardous <br /> Scanned with CarnScanner <br />