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CSG SK-SSL-60X,23 loshua Butler <br /> 03/11/20 13,21 PAGE 1 <br /> Safety-K7een Systems , Inc. <br /> 42 Longwater Drive <br /> Norwell, MA 02061 <br /> 5740 <br /> 24 HR EMERGENCY: 800-468-1760 <br /> (Safety-Kieen) <br /> 2095451011 <br /> CUSTOMER# A421964 American Medical Response REFERENCE NUR. <br /> 3755 West Lo 82612828-2001284350 <br /> Stockton CA 95204-2431 SRVC WEEK: 2020-11 <br /> GILL TO CUSTOMER# PHONE 309-652-4881 SRVC DATE: 03/11/20 <br /> BILL TO ADDRESS: <br /> AM21964 American Medical Response <br /> 3755 West Ln <br /> Stockton CA 95204-2431 <br /> PURCHASE ORDER# PHONE 209-652-4881 <br /> PRODUCT/SERVICES TAX EXEMPT# <br /> SERVICE/ <br /> PRODUCT TDTAL <br /> 3345 DRUM, 30 GL BLACK STEEL 0 QTY UNIT PRICE TAX CHARGE <br /> SERVICE TERM 24 WEEK 1.000 84.1900 7.SS 91.77 <br /> 83383 DRUM-SS WASTE O.F. <br /> SERVICE TERM 8 WEEK 1'Dw 119'2100 0.00 119.21 <br /> 3383 DRUM,55 GAL FOR O.F. <br /> SERVICE TERM 8 WEEK 1`pDO 26.5000 0.00 26.50 <br /> 898560 CARTRIDGE OIL FILTERS SSG <br /> SERVICE TERM 8 WEEK 1.000 305.1700 0.00 305.17 <br /> # CONTS: 1 TSDF: S3 MANIFEST#: 007439040SKS FORM CO. US SHIP# 230933885 <br /> 898560 <br /> CRT#: 200309258089 QTY; 150 WTAOL p <br /> CARTRIDGE OIL FILTERS SSG PROF# 186777 SKROT 7612003 <br /> CAUSE CODE VOIDHEADERANDLINE -SERVICE NOT NEEDED <br /> 0.00 0.00 <br /> 8003369 DRINK, 55 GL BLACK STEEL O <br /> 1342775/ 1.000 85.0000 7.65 92.65 <br /> 875120 LCCRQ SSGL LP AEROSOLS Fp 11000 <br /> CAUSE CODE VOIDHEADERANDLINE -SERVICE NOT NEEDED tl • <br /> 1574380/ 0.00 <br /> 870771 A99P"PEROXIDE FORMING FOR <br /> 1.000#CONTS: 1 .8000 0.00 261 <br /> TSDF: KP MANIFEST#: 007439343SKS FORM ICD: US SHIP# 230933880' <br /> CNT#: 200309ZS806-4 QTY: 150 WT/VOL P PROF# IS74380 SKDOT'8133469 <br /> ® 3230 TAX HANDLING N/C DRUM DROP 30 1.000 0.0000 0.00 0.00 <br /> 100030 RECOVERY FEE <br /> "-- - <br /> ' � 70.5500 6.35 76.90 <br /> TOTAL SERVICE/PRODUCTS --------------------------------- <br /> 952.4200 21.58 974.00 <br /> TOTAL CHARGE 974.Op <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 974.00 <br /> UNPAID BALANCE THIS RECEIPT97 <br /> 4.00 <br /> GENERATOR STATUS <br /> 0"220 lbs/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 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 /> Generator gStatus the aisecorrectalCustoiaerl, and 7agrtheees ababove <br /> referenced <br /> and to be bound by the terms and conditions (1) set the forth bin ove charges <br /> th <br /> General Terms and Conditions provided separately to Customer or)(b)e <br /> any SK agreement signed by Customer and sK, and (2) incorporated <br /> heroin 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) 1.51 per month (18% per annunQ or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstandingCustomer certifies that the individual signing <br /> this Service Acknowiedgement is duly authorized to sign and bind <br /> Customer, Customer acknowledges that it is responsible far maintaining <br /> its Generator Status and Obtaining an EPA IO number if required by <br /> applicable law, <br /> Safety-Kleen's pThe fallowing provision is applicable to <br /> arts cleaner and paint gun cleaner services: Customer <br /> agrees that it will not introduce any substance into the solvent or <br /> aqueous cleaning solution, including without limitation any hazardous <br /> waste or hazardous waste constituent, except to the extent such <br /> introduction is incidental to the normal use of the machine. Customer <br /> further agrees that it will not clean parts/paint guns that have been <br /> contaminated with or Otherwise introduce polychlorinated biphenyls <br /> (PCB's), herbicides, pesticides, dioxins or listed hazardous waste <br /> into the solvent or aqueous cleaning solution, Safety-Kieen has the <br /> capacity and is permitted to accept, store, and/Or reclaim the spent <br /> cust <br /> Parts washer solvent; paint thinners, solvents and paints generated by <br /> omer; or dry cleaning filter cartridges, powder, and still <br /> residues containing perchloroethylene, petroleum naphtha, or <br /> triflurotrichloroethane dry cleaning solvents. Customer agrees that it <br /> is responsible for properly classifying its waste streams as Used Oil <br /> or Nonhazardous Waste in accordance with the provision of 40 CFR <br /> 262.11 and applicable state laws. Customer agrees that it will not <br /> introduce any non-conforming substance into the SK Property, <br /> including, without limitation, any hazardous waste or hazardous waste <br /> eonstituent,Me- polychlorinated biphenyls („PCBs,,), herbicides, <br /> pesticides, dioxins, or listed hazardous wastes) except to the extent <br /> such introduction is incidental to the normal use of the SK Property. <br /> In the event of the <br />