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B4ANCH 718501 CSG 22 COLEMAN,WILLIAM 1%!1,8103 11:20 PAGE 1 <br />Safety-Kleen <br />5400 Legacy Dr. <br />Cluster II, Building 3 <br />Piano, Texas 75024 <br />209-545-1011 <br />REFERENCE 10 <br />CUSTOMER# 371796 FOX RIVER PAPER CO - RIPON 11024979543 <br />SERVICE TAX: 0,07750 942 S STOCKTON AVE SRVC WEEK: 03 �1 <br />COMS TAX: 0.00000 ATTN: ACCTS PAYABLE SRVC DATE: 12/08/03 10:58 <br />PRODUCT TAX: 0.07750 RIPON CA 95366-2784 <br />PHONE 209-599-4241 <br />PURCHASE ORDER#. TAX EXEMPTION NBR. <br />PRODUCT/SERVICES <br />SERVICE/ TOTAL <br />>PRODUCT QTY UNIT PRICE TAX CHARGE <br />SERIAL# <br />00 3230 TAX HANDLING N/C DRUM DROP 1 0.0000 0.00 0.00 <br />00 100001 TEMPORARY FUEL SURCHARGE 1 5.9000 0.00 5.90 <br />00 3395 DRUM,30 GAL FOR O.F. 1 115.0000 0.00 115.00 <br />00 83395 DRUM,30 WASTE U.F. 1 0.0000 0.00 0.00 <br />00 22555 OIL SERVICE (02022555) 1 0.0000 0.00 0.00 <br />CLEAN 0 SPENT 0 <br />SERVICE TERM 12 <br />----------------------------------------- <br />TOTAL. SERVICE/PRODUCTS 120.9000 0.00 120,90 <br />USEPA TRANSPORTER 1 TXR000050930 GENERATOR USEPA CAD009119314 <br />USEPA TRANSPORTER 2 GENERATOR STATE <br />FORM CODE NR <br />US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND 10 <br />DRAINED USED OIL FILTERS <br />(NOT USOOT OR USEPA REGULATED) <br />TOTAL CONT 1 TYPE OM TTL QTY 148 UNIT WT/VOL P SKOOT 1476 <br />CONTAINER# 31115080951 QTY 148 <br />DESIGNATED FACILITY NAME/ADDRESS: <br />SAFETY-KLEEN SYSTEMS, INC. <br />5050 SALIDA BLVD <br />SALIDA CA 95368 <br />USEPA ID NO CAT000613968 TOTAL CHARGE 120.90 <br />STATE 10 NO CATOOD613968 WASTE MIN 0.00 <br />TOTAL OLE 120.90 <br />Machine clean and good 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 />Spent solvent meets accep!ance criteria? Yes <br />GENERATOR STATUS 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 and (ii) no material change las occurred <br />either in the characteristics of the waste materials or in the process <br />generating the waste materials. Customer agrees to pay the above <br />charges and to be bound by the terms and conditions (1) set forth in (a) <br />the General Terms and Conditions provided separately to Customer or <br />(b) 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 fur this <br />transaction. Customer certifies that the individual signing this Service <br />Acknowledgement is duly authorized to sign and bind Customer. <br />IN THE EVENT OF AN EMERGENCY CALL 1-800-468-1760 (24 hours) <br />SIGNATURE NAME: PETER BERTONIS <br />LAST PACE <br />1313(6/99) <br />l ` 5z i <br />DOC. NO. <br />OF LADING <br />)ESTIMATION: <br />SAFETY KLEEN SERVICES. INC. <br />NC. <br />m <br />DATE: ,-77,1 <br />Date: 7� ��- <br />Date: <br />Date: <br />Weight <br />Wt./Item - <br />f <br />148#idm <br />-o3 <br />f� G? <br />Date: 7� ��- <br />Date: <br />Date: <br />