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SI <br /> ED <br /> �E <br /> EI <br /> SEP 3 p 2016 <br /> TAI-HEALTH <br /> � ENVIR�NNIE TMENT <br /> BRANCH SSL CSG 24 David Buxton OSJ11/14 15:38 PAGE 1 <br /> Safety-M een Systems, Inc. <br /> 2600 N Central Expy..5uit* 400 <br /> Richardson, TX 7$080 <br /> CORPORATEr .800-669-3740. . <br /> 24 HR EMERGENCY:.a00-461-1760. 0afaty-K1406) <br /> >309553011 , ., <br /> CUSTOMERS STZ9808 Stockton Rubber Mfg Co Inc. REFERENCE NBR. <br /> 64245143 <br /> 5023 N Flood Rd. SRVC.WEEK: 2014-33 <br /> Linden CA 952n-9455 SRVC DATE: 08/11/14 15:38 <br /> PHONE 209-987-1172 <br /> BILL TO CUSTOMERS BILL TO ADDRESSe <br /> 5729808 Stockton Rubber Mfg Co Inc <br /> 5023 N Flood Rd <br /> Linden CA 9s236-94ss <br /> PHONE 209-887-13,72 <br /> PURCHASE OROER9 <br /> TAX E%EMPTS <br /> PRODUCT/SERVIrCES <br /> sERrrlcE/ TOTAL <br /> PRODUCT QTY, i W-ORICE TAX 'CHARGE <br /> 13431 L'OMS SEC W/CCtAR CHOICE 1.00q ,t298-4400 0.00 Z98.4� <br /> S/N 13053534 CLEAN 1.000 SPENT 0.000 <br /> SERVICE TERM 8 WEEK <br /> 876220 NON PC8 BALLAS'FkSOpPM RE O.OQ1 0.0000 0:00 0.00 <br /> SERVICE TERM 24 WEEK <br /> CAUSE CODE VoidHeaderAoutine -SERVICE NOT NEEOEO <br /> 100001 FEE, FUEL SURCHARGE 1.000 16.1200 0.00 16.12 <br /> ----------------------------------------- <br /> TOTAL SERVICEPRODUCTS 314.5(00 0.00 314.56 <br /> 70TAL CHARGE 314.50 <br /> CREDITS 0.00 <br /> 70TAL DUE -------314.58 <br /> aga�soa..�a <br /> UNPAID BALANCE MIS RECEIPT 314.S6 <br /> Is the.Gan cleaner properly grounded to protect against Static aleClricity?Yes <br /> Is tha eabawst gas piping from this Gay Cleaner vented directly outdoors a#. i* <br /> it vented into (or located insida).�tha paint.spray booth?yes <br /> Machina clean and ggood condition?Yes <br /> Lamp Assembly Condition Yes <br /> Oacals in place and legible?Yes <br /> Fusible link installed?•Yes <br /> Emergency closing of lid arrobstructed?',Yes <br /> Machineproperly grounded?Yes <br /> Local Pkano No. Sticker Affixed to pachine Yes. <br /> Spent solvent meats acceptance criterial Yes" <br /> GENERATOR STATUS <br /> 0-220 lbs/me0th <br /> Custower certifies that (i} the ebove-Turned,oeterials are properly <br /> classified, packaged, uuarked and labeled, and are'in proper condition <br /> fur transportation according to the applicable regulations of the <br /> Department of Transportation and (ii) no meterial cbauge has occarrad <br /> either in the cbaracteristics of the waste/material or in the process <br /> generating the waste material. Customer agrees to pay the above <br /> charges end to be bound by the terms and conditions (1) set forth in <br /> (a) the General Tenn* and Conditions provided separately to Custmiuer <br /> or (b) any SK agrealeant signed by Customer and SK, and (2) <br /> Incorporated herein bi rerereuce. Unless utherwise indicated in the <br /> Payment received sectaen, SK is authorized to charge Customer's <br /> account for this transac.tioa. Custaner certifies that the individual <br /> signing this Service Acknowledgement is duly authorised to sign and <br /> bind Customar. The followinu u,•ov4i4aa 4. a....ie.•.si_ ._ <br />