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BRANCH SSL CSG OIL-60 Joseph R Lina Jr 08/14/15 11:14 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. C IV L <br /> ® <br /> 3739 Stockton Dodge 67659833 <br /> REC <br /> CUSTOMER# S - <br /> SRVC WEEK: 2015-33 -. <br /> 3333 Auto Center Cir - <br /> Stockton CA 95212-2837 SRVC DATE: 08/14/15 11:14 <br /> PHONE 441-000-3000 D E C 2 12015 <br /> - <br /> BILL TO CUSTOMER• BILL TO ADDRESS: <br /> ST37139 Stockton Dodge <br /> 3333 Auto Center Cir <br /> Stockton CA 95212-2837 ENVIRONMENTAL HEALTH <br /> PHONE 441-000-3000 TAX EXEMPT# <br /> PURCHASE ORDER# PERMIT/SERVICES , <br /> PRODUCT/SERVICES TOTAL <br /> SERVICE/ QTY UNIT PRICE TAX CHARGE <br /> PRODUCT <br /> 66655 USED OIL SERVICE NONPREQ 140.000 0.0000 0.00 0.00 <br /> SERVICE TERM 1 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> TOTAL SERVICE/PRODUCTS 0.0000 0.00 0.00 <br /> TOTAL CHARGE 0.00 <br /> CREDITS 0.00 <br /> --------------- . <br /> i <br /> lI1 TOTAL DUE 0.00 " <br /> UNPAID BALANCE THIS RECEIPT 0.00 <br /> If high risk source. SK rep. certifies that load specific PCB & <br /> Silicon testing have been cwigrleted prior to pumping this load. <br /> GENERATOR STATUS <br /> SQG/LQG: Vehicle <br /> Customer certifies that (i) lire above-named materials are properly <br /> classified, packaged, nwrked and labeled, dud are in pruPer cunditiun <br /> for transportatiuo accordingto the applicable regulations Of the <br /> Department Of Transportation and (ii) no materiel change Inas occurred <br /> either in tine chardcteristics Of the wdste/nalerial ar in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by Lire terms and cardit ioru (1) set fuin <br /> sthl <br /> (a) the General Terms and Conditions provided separately to Cuuuxr <br /> or (b) any SK agreement signed by Custamr and SK, and (2) <br /> incorporated herein by reference. Unless othr <br /> ewise indicated in the <br /> payment received section. SK is authorized to charge Custaner's <br /> n. If Custumrer fails to ,oke payment when <br /> account for this transactio <br /> due, an amount equal to the lesser of (i) 1.S% per month (189t per <br /> annWrJ or (i i) the maximuun amount allowed by law, will be added to all <br /> unpaid mounts uutstdodiug. Customer certifies that the individual <br /> signing this Serm <br /> vice Acknowledgeent is duly authorized to sign and <br /> Lint Customer. lfic following provision is applicable to Safety-Kleen's <br /> naris clydr.rr dna !rami 'j cleaner srry icr.: fuaruner dyrera that it <br /> will nut introduce any substance into the solvent or dqueuus clemrunU <br /> i <br />