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<br /> BRANCH SSL CSG 26 Raymond Gomei O6/12/14 10:52 PAGE 2
<br /> �) BRANCH SSL CSG 26 Haymond Gaoler 06/12/14 10:52 PAGE 1
<br /> �IO ( Safety-Kleen Systems, Inc.
<br /> 2600 N Central Espy, Suite 40U
<br /> Richardson, TX %5080
<br /> CORPORA IE: 800-669-5740
<br /> 24 MR EMERGENCY: 800468-1%60 (Safety-M1eeN
<br /> 2095451011
<br /> / REFEENCE NRI1.
<br /> 1 'RW ACI6%%t ,pcme Sew 63B808474
<br /> \ 219 N 5acralmnto St SRVC WEER: 2014-24
<br /> 1 Lodi CA 95240-2132 Sft C DATE: 06/12/14 10:52
<br /> PHONE 209-334-3896
<br /> BILL TO CUSTOMER0 BILL 10 ADDRESS:
<br /> -- AC16091 Acme saw Industrial Supply
<br /> 1204 E Main St
<br /> qI„ Stackton C0. 95205-5514
<br /> PHONE 999-999-9999
<br /> PURCHASE ORDERS PRODUCT/SERVICES TAX EXEry I�
<br /> Nrr.!ru A..u. ; ;.
<br /> tUNYUI<.111. uL1141::•,;tU
<br /> r la: r✓:c..l nn'. 'm. r. q.- f 11......, sERVIce/
<br /> TOTAL
<br /> 2U9S9S IU 11 PRODUCT Q1Y UNIT PLAICE TAX CNAAGt
<br /> IRllUt NII Noll 9463/ MULL 94 W/tial 8 6365 1.000 198.2900 15.46 214.IS
<br /> "�•' 'I" '�"'^' '^^ S/N 60120/1 I" UODU12601K06012013 LLLAY 1.00 SPENI U.IIDU
<br /> '' '+ '••. •• .r .e,, �,:.1 SERVICE TERM 8 WEEK SCANNED YES
<br /> 100001 FEE, FUEL SURCHARGE I.OW 16.4500 1.32 1/./1
<br /> rtrl tun�'• "•1°•� �" Irlr"' - TOTAL SEHVICt/PRUUUl3S 214 1400 17.18 231.92
<br /> 11 al
<br /> r.0, 1 ata iu -., //❑\� TOTAL CHANGE 231.92
<br /> •A u.Lb.n
<br /> -0-,
<br /> I+ •r,:0) 5514 i 111 COEDITS 0.00
<br /> VIOIIII a994 pp]p �y\(\\1
<br /> TOTAL WE --.___.231.92__
<br /> 51 DYp r; UNPAID BALANCE TNLS RECLIPI %f1.92
<br /> PlIMI,. 1 IU"'
<br /> I!\ I:I•I,,,1
<br /> :.a,•. """' °j ' `.. ` oo.. . Machine clean and Yuud cendit imR you M
<br /> Loop Asseubly Condition Yes n Z
<br /> 1,.... 11 AWED , Decals in Place and legible? Yes
<br /> tl11 ''' ' '" •"""�"'- ,,: Fusible link installed? Yes cu C rrL
<br /> Eoxryenq clusing of 1 id ourobstrucled? Yes i*=3 C
<br /> •ala '.I Lvp r,rrvm:.. r 1 nun 'r r
<br /> 1 r• ., Machine?he,,.
<br /> grounded? Yes O Z
<br /> Local ?hone Nu. Sticker acceptance
<br /> to Machine Yes J
<br /> IOIAt IILN.,I ,31 yl, Sprat solvent meets acceptance criteria? You
<br /> aMlnllti UIIU ��
<br /> u N
<br />' IIIIAI IIDL 211.N: im O
<br /> GENERATOR STATUS 'I Cn BaaBn�
<br /> rNri•nv a,:l,w,1 u,., .11 D-i Z0 lbs/month
<br /> r f
<br /> [u cerlifi<a that (i) the above-caned nes Ler ials a r �e>eperly , I
<br /> To,
<br /> ieJ, paete9ed. marked and heb<lell, ani ere 1n t;ouu ud it iuu `—w/
<br /> fur lrmnPor lelimr nca urJ my to the aPlrl iceUle rNul al ions or the
<br /> De hoent of Trans
<br /> Par purlalt i, old (ii) ru m 1.,;.1 IJ.arrye Las .......d
<br /> • ib;,•r.el nv. .....I� 1.• eilLer it ILe Lharac ler ialiu of the was le/nester ial ur in the III ate»
<br /> generating the waste/loafer ial. Cuslmoer eqr<es to Pay the about
<br /> charges and to be bound by the Lerou end conditions Cl) eel forth in
<br /> '•I`�'"r "' .. (a) [b. Gnrcral Trains and C.md it iun, prnu i.l.•A ......mthly to Cu.l.a.wr
<br /> •"' or (b) any SK sru
<br /> yreeent ai,n.d by Cost.,,..- and SK, end (2)
<br /> •_...............r r......:.. r.. ...r....___ n..l..._ ..rr. :.- 0...r%
<br />
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