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CSG SK-SSL-BOX-24 Raymond Gomez 06/27/16 09:59 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# M030843 Moe Auto Repair 70102874 <br /> 2255 S Airport Way SRVC WEEK: 2016-21 <br /> Attn: Moe SRVC DATE: 06/27/16 09:57 <br /> Stockton CA 95206-3338 <br /> PHONE 209-939-1490 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> M030843 Moe Auto Repair <br /> 2255 S Airport Way <br /> Attn: Moe <br /> Stockton CA 95206-3338 <br /> PHONE 209-939-1490 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 94837 MODEL 94 W/2387 & 6365 1.000 199.2300 17.93 217.16 <br /> SIN 12000575 TAG 00001260SK12000575 CLEAN 2.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 3383 DRUM,55 GAL FOR O.F. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 16 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 100001 FEE, FUEL SURCHARGE 1.000 9.8600 0.89 10.75 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 209.0900 18.82 227.91 <br /> TOTAL CHARGE 227.91 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 227.91 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 227.91 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine properly grounded? Yes <br /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <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 /> 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 SK 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 /> Page 1 <br />