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CSG SK -SSL -BOX -21 Jesus Silva 10/04/19 11:17 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 NOR. <br />CUSIOMEH# ROL00/4 Robert J. Norman Farms 81288431-19053054/0 <br />13801 Wildwood Rd SRVC WEEK: 2019-41 <br />Stockton CA 95215-9616 SRVC DATE: 10/04/19 <br />PHONE 209-479-4661 <br />BILL TO LUSIOMER# BILL TO ADDRESS: <br />ROZOO74 Robert J. Norman Farms <br />13801 Wildwood Rd <br />Stockton CA 95215-9616 <br />PHONE 209-479-4661 <br />PURCHASE ORDERS TAX EXEMPTS <br />PRODUCT/SERVICES <br />SERVICE/ TOTAL <br />PRODUCT QlY UNIT PH10E TAX CHARGE <br />83383 DRUM,55 WASTE O.F. 1.000 119.5200 0.00 119.52 <br />SERVICE TERM 24 WEEK <br />3383 ORUM,55 GAL FOR O.F. 2.000 24.2400 0.00 48.48 <br />SERVICE TERM 24 WEEK <br />898560 CAHIH1DGt OIL FILTERS 516 1.000 150.0000 0.00 250.00 <br /># CONIS: 1 ISUF: SJ MAN1FtS1#: 00/158848SKS FORM LU: US SHIPS 2296437/1 <br />CNI#: 193003159551 QIY: 100 WI/VOL P PROF# 156/// SKDOI 7612003 <br />100030 RECOVERY FEE 1.000 33.4400 0.00 33.44 <br />3230 TAX HANDLING N/C UHUM DROP 30 2.000 0.0000 0.00 0.00 <br />---------------------------------- <br />TOTAL <br />-------------------------------- <br />TOTAL SERVICE/PRODU(.TS 427.2000 0.00 451.44 <br />TOTAL CHARGE 451.44 <br />CREDITS 0.00 <br />--------------- <br />TOTAL DUE 451.44 <br />--------------- <br />UNPAID BALANCE THIS RECEIPT 451.44 <br />GENERATOR STATUS <br />0-220 lbs/month <br />CSG SK -SSL -BOX -21 Jesus Silva 10/04/19 11:17 PAGE 2 <br />SHIPPING DOCUMENT <br />1N THE EVENT OF AN thltHGtNCY CALL -24-Hr-Number" 1-800-468-1/60(Safety-Kleen) <br />REFERENCE NOR. <br />CUSIOMtR#/GtNEHAIOH: HOLUO/4 Robert J. Norman Farms 81288431-1901305470 <br />13801 Wildwood Rd <br />Stockton CA 95215-9616 <br />PHONE 209-479-4661 <br />GENERATOR USEPA J.D. CAL000399916 GENERATOR STATE <br />MAN1FtSl#: 00/159009SKS FORM CO: 1D SHIP# 129638598 <br />TRANSPORTER 1 TXR00008120S Safety Kleen <br />S050 SALIDA BLVD <br />SALIDA,CA. 95368 <br />TNSP PHONE: 209-545-1011 <br />TRANSPORTER 2 <br />US UUI UtSCH1P110N (1NCLUUIN6 PHUPtH SHIPPING NAME, HAZARD CLASS, AND IV) <br />NON-RCRA HAZARDOUS WASTE, SOLID <br />(DRAINED/UNDRAINED USED OIL FILTERS) <br />FEDERAL WASTE CODES NONE <br />STATE WASTE CODES <br />TOTAL CONI 1 TYPE OM WT/VOL P SKDO1 1872676 <br />LNI#: 193003158510 SZ: 55 GAL/205 L CONIA1NtRS QTY: 150 PROF# 156033 C <br />DESIGNATED FAC1111Y NAME/ADDRESS: <br />THERMO FLUIDS INC <br />12533 SE CARPENTER OR <br />CLACKAMAS OR 97015-8988 <br />TSD PHONE: $03-788-4616 <br />FACILITY USEPA ID NO OHQOOU025197 <br />FACILITY STATE ID NO <br />GENERATOR STATUS <br />0-220 lbs/month <br />S I UI rit un' <br />CUSTOMER / GENERATOR: robert norman <br />CSG SK -SSL -LIMO -03 Brian Mcdonald 10/11/19 08:47 PAG <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 (Safet)-Kleen) <br />2095451011 <br />UNPAID BALANCE THIS RtCEIPT 59.80 <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 />CSG SK-SSL-UMO-03 Brian Mcdonald 10/11/19 08:47 PA <br />SHIPPING DOCUMENT <br />IN THE EVENT OF AN EMERGENCY CALL -24 -Hr -Number*, 1-800-468-1760(Safety-Kle, <br />CUSTOMER#/GENERALOR: R020014 Hobert J. Norman harms REFERENCE 1 <br />13801 Wildwood Rd 81338904-190538! <br />Stockton CA 95215-9616 <br />NE <br />GENERATOR USEPA 1D. CAL0001999160GENERATOR 209-479-4661GENERATORMANIFEST#: 007157303SKS FORM CD: 10 SHIP# 229681317 <br />TRANSPORTER 1 TXR000081205 Safety Kleen <br />5050 SALIDA BLVD <br />SALIDA,CA. 95368 <br />TRANSPORTER 2 TNSP PHONE: 209-545-1011 <br />US DOT OESCRIPIION (1N(LUUING PROPER SHIPPING NAME, HAZARD CLASS, AND LD) <br />NON-RCRA HAZARDOUS WASTE, LIQUID <br />(USED OIL) <br />FEDERAL WASTE CODES NONE <br />STATE WASTE CODES <br />TOTAL CONT 1 TYPE TT WT/VOL G SKDOT 11249 <br />CN19: 191007215532 SZ: BULK VOLUME CONTAINER QTY: 116 PROF# 156017 <br />DESIGNATED FACILITY NAME/ADDRESS: <br />SAFETY-KLEEN OF CALIFORNIA <br />6880 SMITH AVE. <br />NEWARK CA 94560 <br />TSD PHONE: 510-795-4400 <br />FACILITY USEPA ID NO CAD98OSS7418 <br />FACILITY STATE ID NO <br />GENERATOR STATUS <br />CESQG: Vehicle <br />RECEI"D--- Slyrwiture ----= <br />By Christinte5ba Veffie a,k,1,Q 0 MinOCt 23, 2019 <br />REFERENCE h <br />CUSTOMER# R020074 Robert J. Norman Farms <br />81338904-1905385 <br />13801 WildwoodRd <br />SRVC WEEK: 2015 <br />Stockton CA 95215-9616 <br />SRVC DATE: 10/11 <br />PHONE 209-479-4661 <br />BILL TO CUSTOMERS BILL TO ADDRESS: <br />R020074 Robert J. Norman Farms <br />13801 Wildwood Rd <br />Stockton CA 95215-9616 <br />PHONE 209-479-4661 <br />PURCHASE ORDER# <br />TAX EXEMPI <br />PRODUCT/SERVICES <br />SERVICE/ <br />T01 <br />PRODUCT QTYUNIT PRICE <br />TAX CHARGE <br />66636 USED OIL RECYCLE AUIOM011 116.000 0.3000 <br />0.00 34. <br />SERVICE TERM 24 WEEK <br />HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br />10116 FEE, OIL SERVICE/STOP NON 1.000 25.0000 <br />0.00 25. <br />SERVICE TERM 24 WEEK <br />_. <br />------- -- ------ --. <br />TOTAL SERVICE/PRODUCTS 25.3000 <br />__. <br />0.00 59. <br />TOTAL CHARGE <br />59.1 <br />CREDITS <br />0.f <br />TOTAL DUE <br />------------ <br />59.1 <br />UNPAID BALANCE THIS RtCEIPT 59.80 <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 />CSG SK-SSL-UMO-03 Brian Mcdonald 10/11/19 08:47 PA <br />SHIPPING DOCUMENT <br />IN THE EVENT OF AN EMERGENCY CALL -24 -Hr -Number*, 1-800-468-1760(Safety-Kle, <br />CUSTOMER#/GENERALOR: R020014 Hobert J. Norman harms REFERENCE 1 <br />13801 Wildwood Rd 81338904-190538! <br />Stockton CA 95215-9616 <br />NE <br />GENERATOR USEPA 1D. CAL0001999160GENERATOR 209-479-4661GENERATORMANIFEST#: 007157303SKS FORM CD: 10 SHIP# 229681317 <br />TRANSPORTER 1 TXR000081205 Safety Kleen <br />5050 SALIDA BLVD <br />SALIDA,CA. 95368 <br />TRANSPORTER 2 TNSP PHONE: 209-545-1011 <br />US DOT OESCRIPIION (1N(LUUING PROPER SHIPPING NAME, HAZARD CLASS, AND LD) <br />NON-RCRA HAZARDOUS WASTE, LIQUID <br />(USED OIL) <br />FEDERAL WASTE CODES NONE <br />STATE WASTE CODES <br />TOTAL CONT 1 TYPE TT WT/VOL G SKDOT 11249 <br />CN19: 191007215532 SZ: BULK VOLUME CONTAINER QTY: 116 PROF# 156017 <br />DESIGNATED FACILITY NAME/ADDRESS: <br />SAFETY-KLEEN OF CALIFORNIA <br />6880 SMITH AVE. <br />NEWARK CA 94560 <br />TSD PHONE: 510-795-4400 <br />FACILITY USEPA ID NO CAD98OSS7418 <br />FACILITY STATE ID NO <br />GENERATOR STATUS <br />CESQG: Vehicle <br />RECEI"D--- Slyrwiture ----= <br />By Christinte5ba Veffie a,k,1,Q 0 MinOCt 23, 2019 <br />