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03/27/2018 TUE 16: 17 FAX IQ�QO�/025 <br /> 1 <br /> CSG SK-M-80X-23 Raymond Gomez 03/13/11 12t3B PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Huite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-6695740 <br /> 24 HP EMERGENCY: 800-466-1760 (Safnty-K)non) <br /> 2095451011 <br /> KEFERENCE NBH. <br /> CUSTOMER# 8021038 Bobs Lube & Smog 73019531-1700988615 <br /> 1403 Country Club Blvd SRvc WEEK: 2017-10 <br /> Stockton CA 95204-4910 sRvc DATE: 03/13/11 12:36 <br /> PHONE 209-9433633 <br /> BILL TO CUSTOMER# DILL TO ADDRESS: <br /> 9022519 Bobs Lube z Smog <br /> 1403 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONR 209-943-3633 <br /> PURCHA99 ORDERN TAX EXEMPTN <br /> PRODUCT/SERVICES <br /> SERVTCE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 95 <br /> 98800 A01 SERVICE WITH 6365 1.000 324.23UU 25.13 349.36 <br /> SIN 903003 TAG 000980DOSK0903000B CLEAN 1.00 SPENT 0.000 <br /> SERVICE T=M 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL S7RC11ARGE 1.000 10.0300 0.84 11.67 <br /> ----------------------------------------- <br /> TOTAL SER'ICE/PRODUCTS 335.0600 25.97 361,03 <br /> TOTAL CHARGE 361.03 <br /> CREDITS 0.00 <br /> TOTAL DUE 361.03 <br /> -------------- <br /> i[NPATTt RALANCF THT.S RFCPTPT 361,03 <br /> Machine clean and good condition? Yee <br /> Lamp Assembly Condition Yes <br /> Decals in place and 1 gable? Yea <br /> Fusible link Installs ? Yes <br /> Emergency cloaing of Lid unobatrucLed? Yea <br /> Machine properly grouided? Yea <br /> Local PhOnr, No. Stick r Affixed to Mprhino Yu.-) <br /> Spent solvent moots a r_eptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 !hs/month <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 ac-lording to the applicable regulations of the <br /> Department of Transportation (ii) no material change has occurred <br /> al4her in the charace riat'L0a or the waste/material or in the process <br /> generating the waste/ aterial, and fill) the above referenced <br /> Gcncrator Statu, is n rrcct. Customer Agrees Lo pay Lhe above charges <br /> and to be bound by th torms and condlt•.1pn� (1) ant forl.h In (a) r.hr. <br /> General Terms and Con itions provided goparatoly to puahnmor nr (h) <br /> any SK agreement aign d by Customer and EK, and (2) incorporated <br /> herein by reference. Unlesa otherwise indicated in the payment <br /> received section, SK a authorized to charge Customer's account for <br /> Lila t.ransact:ion. II ueloteer rails to make payment when due, an <br /> nmounh equal to the 1 ager of (1) 1.59 per month (lot per annum) or <br /> (ii) thn msximum amOU it. allowed by law, will be added to all unpaid <br /> amounts outRtand,inv, 'ustomer certifies that the individual signing <br /> this bervice Acknowle gement is duly authorized to aign and bind <br />