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03/27/2018 TUE 16: 20 PAX IQJ008/OZ5 <br /> CSG SM-BBL-BOX-23 Raymond Gomez 06/08/1'1 13:29 PAGE 1 <br /> afety-Mean Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORNITl 800-669-5740 <br /> 24 R CMERGENCYt 800-468.1160 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR, <br /> CUST(k4ER# 8021039 Rohm Lchn R Smog 7388122.9-1707739373 <br /> 1403 Country Club Blvd ERVC WEEK; 2017-23 <br /> Stockton CA 95204-4910 8KVC DATE; 06/08/17 <br /> PHONE: 209-943-3633 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> 8022519 Bobs Lube & Smog <br /> 1403 Country Club Blvd <br /> Stockton CA 95204-4910 <br /> PHONE 209-943-3633 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 95 <br /> 98800 A6 SF,RVICF iTH 6365 1.000 324.2300 2,5.13 34.4.36 <br /> /N 9030008 TAG 00098000SH09030008 CLEAN 1.00 SPENT 0.000 <br /> SERVICE 'f ER 12 WEEK SCANNED NO <br /> lUODUl FEE, FUEL SU CHARGE 1.000 10.8300 0.84 11.67 <br /> ----------------------------------------- <br /> TOTAL SERV CE/PRODUCTS 335.0fin0 25.97 361.03 <br /> TOTAL CHARGE 351.03 <br /> CALUITS 0.00 <br /> --------------- <br /> TOTAL DUE 361.03 <br /> --------------- <br /> UNPAID BALANCE HIS RECEIPT 361.03 <br /> Machine clean and good condition? Yea <br /> Lamp Assembly Conditio Yea <br /> Decals in place and Is able? Yea <br /> Fusible link instaEl <br /> d Yea <br /> Emergency closing d unobstructed? Yea <br /> Machine properly ged? Yea <br /> Local Phone No. Sticks Affixed to Machine Yea <br /> Spe;hC solvent mGete ac eptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 lbe/month <br /> CuxLumer cerl.lrlea that. (1) l.he Abuve-named mal.erials are properly <br /> c1Axsifind, prrkagnd, tkmd And labeled, and are-. In proper condition <br /> for transportation acro ding to the applicable regulations of. the <br /> Department of 1'ranaport tion ill) no material change has occurred <br /> either in the character sties of the waste/material or in the process <br /> generating the waste/ma erial, and (ill) the above referenced <br /> (,eneratur Status le cor ect. Customer agrees to pay the above charges <br /> .and to be bound by the erme and conditions 11) set forth In (a) the <br /> General 'Perms and CondL Ione pravldC;t separately to Customer or (b) <br /> any 5K agreement signed by Customer and BK, and (2) incorporated <br /> herein by reference. U less otherwLao indicated in the payment <br /> received section, SM is author.laed to charge Cuotomor',) account, for <br /> this transaction. If Cu tomer fails to make payment when dun, an <br /> amount equal to the lea er of (1) 1.59 per month (189 per annum) or <br /> (111 the maximum amount allowed by law, will be added to all unpaid <br /> dmuunta uulsL'dridiny. Cu turner certifies that the individual signing <br /> thin Srrvlre Ac:knowledy meat is duly authorized t0 sign and bind <br />