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CSG SK-SSL-BOX-23 Raymond Gomez 04/09/18 09:53 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# IT10046 ITS Technologies 76486153-1801577514 <br /> 6540 Austin Rd SRVC WEEK: 2018-13 <br /> Stockton CA 95215-9662 SRVC DATE: 04/09/18 <br /> PHONE 209-450-9035 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> IN30053 In-Terminal Svc <br /> 6540 Austin Rd <br /> Stockton CA 95215-9662 <br /> PHONE 999-999-9999 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 960444/ <br /> 875460 CNO-NON HAZARDOUS SOLID 5 3.000 344.1400 0.00 1032.42 <br /> SERVICE TERM 12 WEEK <br /> # CONTS: 3 TSDF: SJ MANIFEST#: 006513734SKS FORM CD: US SHIP# 225087056 <br /> CNT#: 180327464310 QTY: 300 WT/VOL P PROF# 960444 SKDOT 7582963 <br /> CNT#: 180327464311 QTY: 300 WT/VOL P PROF# 960444 SKDOT 7582963 <br /> CNT#: 180327464313 QTY: 300 WT/VOL P PROF# 960444 SKDOT 7582963 <br /> 3383 DRUM,55 GAL FOR O.F. 4.000 21.9400 0.00 87.76 <br /> SERVICE TERM 12 WEEK <br /> 83383 DRUM,55 WASTE O.F. 2.000 80.0000 0.00 160.00 <br /> SERVICE TERM 12 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 12.4800 0.00 12.48 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 4.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 458.5600 0.00 1292.66 <br /> TOTAL CHARGE 1292.66 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 1292.66 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 1292.66 <br /> GENERATOR STATUS <br /> 0-220 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 /> any SK agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (18o per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br />