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CSG SK-SSL-BOX-23 David L Buxton 03/22/16 13:19 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# TC10591 Tci 69867817 <br /> 2150 W Charter Way SRVC WEEK: 2016-13 <br /> Stockton CA 95206-1118 SRVC DATE: 03/22/16 13:16 <br /> PHONE 209-941-4034 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> TC10592 Tci <br /> 4950 Triggs St <br /> Commerce CA 90022-4832 <br /> PHONE 999-999-9999 <br /> PURCHASE ORDER# sh207807 TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 83383 DRUM,55 WASTE O.F. 3.000 45.0000 0.00 135.00 <br /> SERVICE TERM 12 WEEK <br /> 94837 MODEL 94 W/2387 & 6365 1.000 149.8900 13.49 163.38 <br /> SIN 10007844 TAG 00001260SK10007844 CLEAN 2.00 SPENT 0 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 3383 DRUM,55 GAL FOR O.F. 3.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 8.5800 0.77 9.35 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 3.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 203.4700 14.26 307.73 <br /> TOTAL CHARGE 307.73 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 307.73 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 307.73 <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 /> 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 and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br />