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� V <br /> �ke,3 <br /> eo <br /> ENVIRONpAR-�NIEN� <br /> BRANCH SSL CSG 24 David Buxton 10/09/14 12:50 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 400 <br /> Richardson. TX 75000 <br /> CORPORATE: 000-669-5740 <br /> 24 BR EMERGENCY: 600-460-1760 (Safety-K1eea) <br /> 2095451011 <br /> ' CUSTOMER# ST29SOS Stockton Rubber Mfg Cc Inc REFERENCE NBR. <br /> 5023 N Flood Rd 65030199 <br /> Linden CA 95236-9455SRVC WEEK: 2014-41 <br /> PHONE 200-687-1172 SRYC DATE: 10/09/14 12:50 <br /> BILL TO CUSTOMER# BILL 70 ADDRESS: <br /> 5129608 Stockton Rubber Mfg Co Inc, <br /> 5023 N Flood Rd <br /> Linden CA 05236-9455 <br /> PHONE 209-487-1172 <br /> PURCHASE ORDERS. TAX EXEMPTS <br /> SERVICE/ PRODUCT/SERVICES <br /> ' <br /> PRODUCTTOTAL <br /> 4TY UNIT PRICE TAX CHARGE <br /> 13131 COMS SEC W/CLEAR CHOICE 1.000 298.4400 0.00 296.44 <br /> S/N 130S3S34 CLEAN 1.000 SPENT 0.000 <br /> SERVICE TERM a WEEK <br /> 100001 FEE. FUEL SURCHARGE 1.000 15.7900 0.00 15.79 <br /> --------- ------------------- <br /> 'TOTAL SERVICE/pRODOCTS 314.2300 0.00 314.23 <br /> TOTAL CHARGE 314.23 <br /> CREDITS 0.00 <br /> 1 <br /> --------------- <br /> TOTAL DUE314.23 <br /> =am�samasmsaam <br /> UNPAID BALANCE 'TUTS RECEIPT 314.23 <br /> Is the Gun cleanar µroperly greanded to protect against static electricity?Yes <br /> Is the exhaust gas pipirrg from this Gun Cleaner vented directly outdoes-% or is <br /> it vented into (or located inside) the paint spray beth? Yes <br /> i 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 /> 0-224 lbs/eanth <br /> Customer certifies that (i) the above-oohed 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 and (ii) no material change has occurred <br /> either in the characteristics of the waste/nxiterial or in the process <br /> generating the waste/material. Custonmr agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SK, and (2) <br /> incorporated herein by reference. Unless ethos-wise indicated in the <br /> payment received section. SK is authorized to charge Customer's <br /> account for this transaction. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorized to sign and <br /> bind Customer. 'The fallowing provision is applicable to Safety`Kleen's <br /> parts cleaner and pai <br /> ... nt gun cleaner services: Customer agrees that it <br /> ...e.. _ . ,...... .._ . <br />