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R BRANCH SSL CSG UM0-01 Joseph R Lima Jr 10/23/15 11:24 PAGE 1 i <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. <br /> CUSTOMERS ST37139 Stockton Dodge 68312921 <br /> 3333 Auto Center Cir SRVC WEEK: 2015-43 RECEIVED <br /> Stockton CA 95212-2837 SRVC DATE: 10/23/15 11:24 <br /> PHONE 441-000-3000 DEC 2 12015 <br /> BILL TO CUSTOMER• BILL TO ADDRESS: <br /> ST37139 Stockton Dodge <br /> 3333 Auto Center Cir <br /> Stockton CA 95212-2837 <br /> PURCHASE ORDER# PHONE 441-000-3000 ENVIRONMENTAL HEALTH <br /> PRODUCT/SERVICES TAX EXEMPT# PERMIT/SERVICES <br /> J' SERVICE/ <br /> PRODUCT QTY UNIT PRICE TOTAL <br /> TAX CHARGE <br /> 66636 USED OIL NON-PREQUAL SERV 335.000 25.0000 0.00 25.00 ' <br /> SERVICE TERM 1 WEEK - <br /> HALOGEN /CLOR-O-TECT TEST RESULT PASS: PPM < JUDO <br /> -------------------------------- <br /> TOTAL SERVICE/PRODUCTS 25.0000 0.00 25.00 <br /> TOTAL CHARGE 2S.00 <br /> CREDITS 0.00 <br /> ------------- <br /> TOTAL DUE 25.00 - <br /> UNPAID BALANCE THIS RECEIPT 25.00 <br /> If high risk source, SK rep. certifies that load specific PCB 8 <br /> Silicon testing have been completed prior to pumping this load. <br /> GENERATOR STATUS _ <br /> SQG/LQG: Vehicle <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 has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Te"Is and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. If Customer fails to make payment when <br /> due, an amount equal to the lesser of (i) 1.5% per month (18% per <br /> annum) or (ii) the maxinmim amount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authcrized to sign and <br /> bind Customer. The following provision is applicable to Safety-Kleen's <br /> parts cleaner and mdint nun cleaner serv;ces: custu.er a,.�.-. mi..� ,• <br />