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CSG SK-SSL-UMO-01 Joseph R Lima Jr 09/13/17 08:41 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. <br /> CUSTOMER# OR14384 O'Reilly # 2567 74779087-1704611255 <br /> 1440 E Harding Way SRVC WEEK: 2017-37 <br /> Stockton CA 95205-3104 SRVC DATE: 09/13/17 <br /> PHONE 972-555-1247 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> OR10217 O'Reilly Auto Parts <br /> 233 S Patterson Ave <br /> Attn Tom Scheldt <br /> Springfield MO 65802-2210 <br /> PHONE 972-265-2485 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 22558 DIY OIL 185 GALLONS TANK 1.000 <br /> S/N 517555 TAG T0002235XX00342467 <br /> SERVICE TERM 2 WEEK SCANNED NO <br /> 66668 DO-IT-YOURSELF OIL SERVIC 155.000 <br /> SERVICE TERM 4 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS <br /> TOTAL CHARGE <br /> CREDITS <br /> --------------- <br /> TOTAL DUE <br /> UNPAID BALANCE THIS RECEIPT <br /> If high risk source, rep. certifies that load specific PCB & Silicon <br /> testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: 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 (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material, and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above charges <br /> and to be bound by the terms and conditions (1) set forth in (a) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> any SIC agreement signed by Customer and SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (18% per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br />