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BRANCH SSL CSG 24 David Buxton 05/12/15 15:47 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-Kleenl <br /> 2095451011 <br /> REFERENCE NSR. <br /> CUSTOMER# LK00044 Lkq 66758138 <br /> 2041 Navy or SRVC WEEK: 2015-20 <br /> Attn Jerry SRVC DATE: 05/12/15 15:46 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> SILL TO CUSTOMER{# BILL TO ADDRESS: <br /> LK00044 Lkq <br /> 2041 Navy Or <br /> Attn Jerry <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 w/2387 a 6365 1.000 316.0500 28.44 344.49 <br /> S/N 118982 TAG TOOOOODOXX90209571 CLEAN 3.00 SPENT O.O00 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 11.8200 1.06 12.88 <br /> ----------------------------------------- <br /> TpTAL SERVICE/PRODUCTS 327.8700 29.50 357.37 <br /> TOTAL CHARGE 357.37 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 357.37 <br /> UNPAI❑ BALANCE THIS RECEIPT 357.37 <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 ji) 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 ❑f 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 />