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-.:1.rn0y 3'.Romer* 07/17/15 09.32 PAGE i
<br /> Safety-Kleen Systems, Inc.
<br /> 2600 N Central Expy, Siuite 200
<br /> Richardson, TK 75080
<br /> CORPORATE: 800-669-5740
<br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen)
<br /> 1095441011
<br /> REFERENCE NBR.
<br /> OMER@ 5729308 Stockton Rubber Mfg Co Inc 67356298
<br /> 5023 N Flood Rd SRVC WEEK: 201S-29
<br /> Linden CA 95236-9455 SRVC DATE: 07/17/15 09:32
<br /> PHONE 209-887-1172
<br /> . 70 CUSTUMERM BILL TO ADDRESSi
<br /> '808 Stockton Rubber Mfg Co Inc
<br /> 5023 N Flood Rd
<br /> Linden CA 95236-9455
<br /> PHONE 209-887-1172
<br /> 'HASE ORDER# - TAX EXEMPTN
<br /> 3MCE/
<br /> PRODUCT/SERVICES
<br /> TOTAL
<br /> .ODUCT $TY UN T PRICE TAX CHARGE
<br /> 1 COMS SEC W/CLEAR CHOICE 1.000 314,8400 0.00 314.84
<br /> SIN 13043534 CLEAN L.Odo SPENT 0.000
<br /> SERVICE TERM 8 WEEK
<br /> '461
<br /> 160 CNO-NON HAZARDOUS SOLID 5 1.000 0.0000 0,00 0.00
<br /> SERVICE TERM 8 WEEK
<br /> CAUSE CODE VoidHeaderAndline -SERVICF NOT NEEDED _
<br /> 101 FEE, FUEL SURCHARGE 1.000 12.1500 0.00 12.15
<br /> TOTAL SERVICEIPRODUC'T'S 326.8900 0.00 326.99
<br /> TOTAL CHARGE 326.99
<br /> CREOX75 0.00
<br /> ---------------
<br /> 70TAL DUE 326.99
<br /> aeear_eYaas.aa
<br /> UNPAID BALANCE THIS RECEIPT 326,99
<br /> he Glen cleaner properly gruunlRrd to yrulrck -Jlinst !static.
<br /> :tricity? Yes
<br /> :he erhrYiyQas p'ipiwq frena tris r,N, rleunrr vrnlad irrctly
<br /> toors or is
<br /> it vented iota (or lrrntwd inside•) thr Swint spray RECEIVED
<br /> tin Yes
<br /> rine clean and good condition?Yes
<br /> /Assembly Condition Yes
<br /> t1s in place and legible?Yes SEP 3 0 20 16
<br /> able link installed? Yes
<br /> -gency closing of lid unobstructed?yes
<br /> line properly grounded? Yes
<br /> nl Phone No. Sticker Affixed to Machine Yes
<br /> it solvent moats acceptance criteria?Yes
<br /> ENVIRONMENTAL HEALTH
<br /> DEPARTMENT
<br /> 'RATOR STATUS
<br /> to lba/month
<br /> Lamer certifies Visit Ci) the ahuve-nzvucJ eratcrials d•e properly
<br /> .sified, packaged, olar•ked avid labeled, and,ire in Proper'Lund It IMI
<br /> Lr•anspor tat iva accoreg
<br /> ding to lire applicable ralatiuus of the '
<br /> srtment of Transpel-LaLiun and (ii) no ixaLerial change has occurred
<br /> wr iu Use 11rarntler ial its of the was talnwier int or m UIe prucesa '
<br /> craLiny Else wabWnmLerial. CasLonon. aV,-". to Fay Lha ish.,m
<br /> �'eea alrl LY be LuuaJ by Use Lanus giant cond.Liuub (1) sal rurth is
<br /> the General Turins and Carditiuns provided sep,iratoly to Customer
<br /> (b) any SK agreement signed by Customer and SK, and (2)
<br /> jrpurateJ her•eiu bz refareaLe. Uulebs otherwLise indicated in the
<br /> oust received section, SK is aetherized to charge Custuswur'b
<br /> oust fur this Lr'anb.LL'rell. Cuslrwrler certifies that the indivjdual
<br /> nI" this Servica Adisuwledvwlart is duly du imr bed to sign and
<br /> J Custarmr. The folluwing Provibiar is applicable to Safety-Kleen's
<br /> 6 cleaner and paint gun daaeer services: CusLVlner agraas that it
<br /> 1 ....1 w1u1...- L.I. 7t.- -,—I . .1-4-,limitation
<br /> dry hazardous waste or
<br /> ardous waste constituents except to the extAant such introduction is
<br /> iJcnLal to Lbs nu-ml use of Live macirilra. `YbtV11N' PurLbar rcyreas .
<br /> L it will net clean parts/paiot gurrs tlmt have been eunlatsinaled
<br /> Ir or otherwise inti-educe polychlorinated biphenyls (PCB's),
<br /> J... P-Lis;J... Jiuw..w u1 1i4L.J L-4J.n.s wast. into ire
<br /> .1.
<br /> .qu.....- ,'._ ....., -40:.... f_:y Z..r.. 1— ;.- -r^•.::y
<br /> Is Permitted to accept, store, and/or reclaim the spent Parts
<br /> ser soivanl: point Lbinaers. sulvants and paints guml.aled by
<br /> tomer; or dry cleaning filter cartridges. Powder, and still
<br /> ideas auntaininl, perclrluroet6yiene. Patrulim,uaphtha, or
<br /> rlalai,isbl v.vali.waa is, s1ale a.. —A.. .,.a. ".— Us-
<br /> responsible fur properly classifying its Nastesbtreayo as Ubad Oil'
<br /> i..r,lla.a.Jur-Pesti• .,1 .. ..I-YL- ..isl. li- ,,.»..-iu„ ..r is rrR
<br /> .tl :amt ty,pli:able elate los, rasllaarl• nein, t11at it will Not
<br /> VJYce aYy IW,.-♦YrfVll„,,,y JYba LY1.V. ;-L- U- SK P.'Vp..'Ly. e
<br /> lY4,10. wiLi.vYL :i.sdrlim., Ply Is—Join .-L. .. i,w.rrJura ._Ls '
<br /> st i Luart.(i.e., pulyLlrlar illatol b iphenylb ("lyes”), herb is idea,
<br /> • , IIIC). ti,Vw-,,a. VI IIst.J i,a.a,JVP! --L—)L—) —,.p; LV Us. .w1.,.L '
<br /> It introduction is incidental to the normal use of the SK Property.
<br /> Lbs VOYi yr Lha inLrYJYSio.. r YcR ..uu-.wfv,wiry b....J.rs
<br /> Lc, C•»iwlwr rylzcs M.t .1 ..111 Lc r:.r all
<br /> -iiw2ir- e.y:.sc- .'1 ted '
<br />
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