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BRANCH 718501 CSG 22 COLEMAN,WILLIAM 03122104 12:01 PAGE 1 <br />Safety•-KIeen <br />5400 Legacy Dr, <br />Cluster 11, Building 3 <br />Plano, Texas 75024 <br />209-545-1011 <br />REFERENCE NBR <br />CUST�Rq 371796 FOX RIVER PAPER CO - RIPON 0025728642 <br />SERVICE TAX: 0.07750 942 S STOCKTON AVE SRVC WEEK: 04-12 <br />COMS TAX: 0.00000 ATTN: ACCTS PAYABLE SRVC DATE: 03122/04 11:43 <br />PRODUCT TAX: 0.07750 RIPON CA 95356-2784 <br />PHONE 209-599.42.41 <br />PURCHASE ORDER# 19905 TAX EXEMPTION NBR: <br />PRODUCT/SERVICES <br />SERV ICE 1 <br />PRODUCT <br />SERIAL# <br />00 100001 TEMPORARY FUEL SURCHARGE <br />00 3230 TAX HANDLING NIC DRUM DROP <br />00 7530 SORBENT SVC 55 PADS <br />00 11801 IC W1 PWR HEAD W/ AQUEOUS <br />32013 CLEAN 2 SPENT 25 <br />SERVICE TEAM 12 <br />00 90830 CIRCULATING CLEANER W1 AQUE <br />21026 CLEAN 5 SPENT 15 <br />SERVICE TERM 12 <br />00 90830 CIRCULATING CLEANER W1 AQUE <br />21062 CLEAN 5 SPENT 13 <br />SERVICE 1ER14 12 <br />00 92383 2363 PUMP ASSEMBLY <br />1 CLEAN 0 SPENT 0 <br />SERVICE TERM 12 <br />CAUSE CODE 4 INV CODE T <br />00 92383 2383 PUMP ASSEMBLY <br />2 CLEAN 0 SPENT 0 <br />SERVICE TERM 12 <br />CAUSE CODE 4 INV CODE T <br />QTY UNIT PRICE <br />TOTAL <br />TAX CHARGE <br />1 5.9000 0.00 5.90 <br />1 0.0000 10.00 0.00 <br />1 549.0000 0.00 549.00 <br />1 228.2500 17.69 245.94 <br />223.7500 17.34 241 09 <br />1 223.7500 17.34 241,09 <br />1 0.0000 0.00 0.00 <br />1 0.0000 0.00 0.00 <br />----------------- ----- <br />TOTAL SERVICEIPRODUCTS 1230.6500 <br />----------------- <br />52.37 1283.02 <br />&009119314 <br />USEPA TRANSPORTER 1 TXR000050930 GENERATOR USEPA <br />USEPA TRANSPORTER 2 GENERATOR STATE <br />MANIFEST DOC # 23470379 FORM CODE CA TRACKING # 104542603 <br />US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD <br />CLASS, AND ID <br />USED CLEANING COMPOUNDS, N.O.I.B.N. <br />LIQUID (NGT USDOT OR USEPA REGULATED) <br />AQUEOUS PARTS WASHER SOLUTION (8.3#GAL) <br />TOTAL CONT 2 TYPE DM TTL QTY 28 UNIT <br />WT/VOL G SKDOT 941 <br />CONTAINER# 40228073590 QTY 15 <br />CONTAINER# 40228073591 QTY 13 <br />USED CLEANING COMPOUNDS, N.0.I.B.N. <br />LIQUID (NOT USDOT OR USEPA REGULATED) <br />AQUEOUS IMMERSION CLEANER (8.4#GAL) <br />TOTAL CONT 1 TYPE DM TTL QTY 25 UNIT <br />WT/VOL G SKOOT 3311 <br />CONTAINER# 40228073658 QTY 25 <br />DESIGNATED FACILITY NAMEIADDRESS: <br />SAFETY-KLEEN SYSTEMS, INC. <br />5050 SALIDA BLVD <br />SALIDA CA 95368 <br />USEPA ID NO CAT000613968 TOTAL CHARGE <br />1,283.02 <br />0.00 <br />STATE ID NO CAT000613968 WASTE MIN <br />------------- <br />TOTAL DUE <br />1,263.02 <br />Machine clean and good condition? Yes <br />Customer certifies that (i) the above-named materials arero rl <br />classified, packaged, marked and labeled, and are in proper <br />Decals in place and legible? Yes <br />Fusible link installed? Yes <br />condition <br />for transportation accordirrg to the applicable regulations of the <br />Department of Transportation and (ii) <br />Emergency closing of lid unobstructed? Yes <br />no material change has occurred <br />either in the characteristics of the waste materials or in the <br />Machine properly grounded? Yes <br />Spent solvent meets acceptance criteria? Yes <br />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 <br />GENERATOR STATUS 220 - 2200 lbs/month <br />in (a) <br />the GeneralTermsand Conditions provided separately to Customer or <br />(b) signed botherwomeriandSK,andincorporated <br />herein ragreement <br />(2) nt <br />received section, SK is authorized to charge Customer's account for this <br />transaction. Customer certifies that the individual <br />is signing this Service <br />to sign <br />IINkTI,EIEVEN� OF AN EMERGFW:YoCALLd 1-800-468r1760�(24J hours) <br />