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CSG SK-SSL-BOX-21 Brandon J Gaither 10/02/19 10:53 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# BR26816 Brocchini Farms Inc 81080947-1904804790 <br /> 27011 S Austin Rd SRVC WEEK: 2019-40 <br /> Ripon CA 95366-9625 SRVC DATE: 10/02/19 <br /> PHONE 209-599-4229 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> BR26816 Brocchini Farms Inc <br /> 27011 S Austin Rd <br /> Ripon CA 95366-9625 <br /> PHONE 209-599-4229 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 W/2387 & 6365 1.000 375.4500 29.10 404.55 <br /> SIN 19470 TAG TOOOOOOOXX90209368 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 8 WEEK SCANNED NO <br /> 100030 RECOVERY FEE 1.000 30.0400 2.33 32.37 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 405.4900 31.43 436.92 <br /> TOTAL CHARGE 436.92 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 436.92 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 436.92 <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 /> 220-2200 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 />