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BRANCH SSL CSG UMB-01 loseph R Lima Ir 11/06/1S 12:39 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Etpy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> CUSTOMER• 5737139 Stockton Dodge REFERENCE NBR. <br /> 3333 Auto Curter Cir 68422316 <br /> Stockton CA 95212-2837 SRVC WEEK: 2015-45 <br /> SRVC DATE: 11/06/15 12:39 <br /> PHONE 411-000-3000 <br /> HILL TO CUSTOMER; BILL TO ADDRESS: <br /> ST37139 Stockton Dodge <br /> 3333 Auto Center Cir <br /> Stockton CA 95212-2837 77-- <br /> PURCHASE ORDER• <br /> PHONE 441-000-3000 =:� .� <br /> � <br /> TAX EXEMPT! — <br /> PRODUCT <br /> PRODUCT/SERVICES <br /> wEu <br /> SERVICE/ TOTAL OEC 2 l 2015 <br /> QTY LOWY PRICE TAX CHARGE <br /> 66636 USED OIL NON-PREQUAL SERV 290.000 25.0000 0.00 2500 <br /> SERVICE TERM 1 WEEK 25.00 <br /> HALOGEN HALOGEN /CLOR-D-TECT TEST RtSULT PASS: PPM < 1000 <br /> ----------------------------------------- PEPMIT/SERVICES TOTAL SERVICE/PRo0uCT5 25.0000 0.00 25.00 <br /> TOTAL CHARGE 25.00 - <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 25.00 <br /> .j UNPAID BALANCE THIS RECEIPT 25.00 <br /> If high risk source, SK rep. certifies that load specific PCB & <br /> Silicon testing have been coupleted prior to pulping this load. <br /> GENERATOR STATUS - <br /> SQG/LQG: vehicle <br /> Custooeer certifies that (i) the above-name) materiel-s are properly <br /> Classified- packaged, nwrked and labeled, and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Departimnt of Transportation tend (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. Custmoer agrees to pay the above <br /> charges and to he bound by the terms and conditions (1) set forth in <br /> (dt) the General Tenth 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 anount equal to the lesser of (i) 1.5% per inonth (18% per <br /> ennui or (ii) the maaimun mount allowed by law, will be added to all <br /> unpaid amounts outstanding. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br /> bind Customer. The following provision is applicable to Safety-Kleen's <br /> parts cleaner and paint gun cleaner services: Custuner agrees that it <br /> H1-1V3H 1VLN3WN081/W3 <br /> SIR <br /> (13A130 <br /> r • <br />