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BRANEh 718501 CSG 22 COLEMAN,WILLIAM 04113iG4 09:51 PAGE 1 <br />Safety-Kleen <br />5400 Legacy Dr, <br />Cluster II, Building 3 <br />Plano, Texas 75024 <br />209-545-1011 <br />REFERENCE NBR <br />CUSTOMER# 371796 FOX RIVER PAPER CO - RIPON 002.5782046 <br />SERVICE TAX: 0.07750 942 S STOCKTON AVE SRVC WEEK: 04-15 <br />CODS TAX: 0.00000 ATTN: ACCTS PAYABLE SRVC DATE: 04'13104 <br />09:50 <br />PRODUCT TAX: 0.07750 RIPON CA 95366.2764 <br />PHONE 209-599.4241 <br />PURCHASE ORDER# 19905 TAX EXEMPTION NBR: <br />PRODUCT/SERVICES <br />SERVICE! <br />TOTAL <br />PRODUCT QTY UNIT PRICE TAX <br />CHARGE <br />SERIAL# <br />00 3230 TAX HANDLING NIC DRUM DROP 1 0.0000 0.00 <br />0.00 <br />OD 100001 TEMPORARY FUEL SURCHARGE 0 0.0000 0,00 <br />0,00 <br />00 3395 DRUM,30 GAL FOR O,F, 1 115,0000 0.00 <br />115.00 <br />00 83395 DRUM,30 WASTE U.F. 1 0.0000 0100 <br />0.00 <br />00 22555 OIL SERVICE (02022555) 1 0.0000 0.00 <br />0,00 <br />CLEAN 0 SPENT 0 <br />SERVICE TERM 4 <br />----------------------------------------- <br />-iOTAL SERVICEIPRODUCTS 115.0000 0.00 <br />115.00 <br />USEPA TRANSPORTER 1 TXR000060930 GENERATOR USEPA CAD009119314 <br />USEPA TRANSPORTER 2 GENERATOR STATE <br />FORM CODE NR <br />US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID <br />OFF-SPEC PRODUCT <br />(NOT USOOT OR USEPA HAZARDOUS MATERIAL) <br />TOTAL CONT 1 TYPE OM TTL QTY 148 UNIT WTIVOL P SKDOT 3924 <br />CONTAINER# 40112011915 QTY 148 <br />DESIGNATED FACILITY NAMEIADORESS: <br />SAFETY-KLEEN SYSTEMS, INC, <br />5050 SALIDA BLVD <br />SALIDA CA 95366 <br />USEPA ID NO CAT000613968 TOTAL CHARGE <br />115.00 <br />STATE ID NO CAT000613968 WASTE MIN <br />0.00 <br />TOTAL DUE <br />115.00 <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 acceptance criteria? Yes <br />GENERATOR STATUS 220 - 2200 Ibslmonth <br />Customer certifies that (1) 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 has 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 for 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: R SCHNEIDER <br />LAST PAGE <br />