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Safety-Kleen Systems, Inc.
<br /> 2600 N Central Expy, Suite 200
<br /> Richardson. 7X 75060
<br /> CORPORATE: 890-609-5740
<br /> 24 HR EMERGENCY: 800-468-1760 !Safety-Kleen)
<br /> 2095451011
<br /> REFERENCE NOR.
<br /> CUSTOMERS S'R9808 Stockton Rubber Mfg Co Inc 67356298
<br /> $023 N Flood Rd SRVC WEEK: 2015-29
<br /> Linden CA 95236-9455 SRVC DA-M, 07/17/15 09:32
<br /> PHONE 209-867-1172
<br /> HILL TD CUSTOMER; BILL 10 ADDRESS:
<br /> ST29808 Stockton Rubber Mfg Co Inc
<br /> 5023 N Flood Rd
<br /> Lindon CA 95236-9455
<br /> PRONE 209-887-1172
<br /> PURCHASE ORDER# TAX EXEMPT#
<br /> PRODUCT/SERVICES
<br /> SERVICE/ 70TAL
<br /> PRODUCT QTY UNIT PRICE TAX CHARGE
<br /> 13131 COMS SEC W/CLEAR CHOICE 1.000 314.8400 0.00 314.84
<br /> SA 13053534 CLEAN I.00D SPENT 0.000
<br /> SERVICE TERM 8 WEEK
<br /> 691746/
<br /> 575360 CNO-NON HAZARDOUS SOLID S 1.000 0.0000 0.00 0.00
<br /> SERVICE TERM 8 WEEK
<br /> CAUSE CODE VoitieadorAndtine -SERVICE NOT NEEDED
<br /> 100001 FEE, FUEL SURCHARGE 1.000 12.1500 0.00 12.15
<br /> --------------------------------•------
<br /> TOTAL SERVICE/PRODUCTS 326.9900 0.00 326.99
<br /> 70TAL CHARGE 326.99
<br /> CREDITS 0.00
<br /> TOTAL DUE 326.99
<br /> UNPAID BALANCE THIS RECEIPT 326.99
<br /> Ts the Grin :leaner prUparly gruunttrd tv prwtwe ruaiast static
<br /> electricity? Yes
<br /> Ts the rrhauat gga, p'ipirg frwm this Gun Clr..aer wmtvd dirrrtly
<br /> outdoors or is it vented iwM (or lwntrd incidr) the paint spray _
<br /> Machin Yes RECEIVED
<br /> Machine clean and good condition?Yes
<br /> Lang Assembly Condition Yes
<br /> Decals in place and legible? Yes
<br /> Fusible link installed?Yes
<br /> Emergency closing of lid unobstructed? Yes SEP 3 0 2 016
<br /> Machine properly grounded?Yes
<br /> Local phone No. Sticker Affixed to Machine Yes
<br /> Spent solvent meets acceptance criteria?Yes
<br /> ENVIRONMENTAL HEALTH
<br /> GENERA70R STATUS DEPARTMENT
<br /> 0-220 lbs/rironth
<br /> Costumer certifies that (I) kilo abuve-umund Uiaterials are properly
<br /> claaaified, packaged, niarkol and labeled, and are in proper c.nilMun
<br /> fur tranayurlrLion accurdin9 to tine apPlicabla regulations of the
<br /> Department of Traraportd.ion and (i i) no material charge has ussarred
<br /> either it, Use cd,ar•acLer;aL na or the i,aa Le/auto r;al .r is Use prwsoa
<br /> geao•aL;.e Lite waste Am L.r;al. C..L.mer agreva L. Pay LLe alar.
<br /> chargeb tJ to be bound Ly the teu•aa .04 —OtI .a. (1) bet r.r[Ir ;n
<br /> (a) the General Terms and Conditions provided s
<br /> � y apar•ate7y W Custwuar _
<br /> or (b) any SK agreement signed by Customer and 5K, and (7.)
<br /> incur•puraled hare*" bxx reremnca. Unless otherw;sa indicated in the
<br /> payment received bactioit, St is aetharic.d to charge Cuatrmwr's
<br /> account Fur this transaction. CUatItglE1•'.arLifiea that the individual
<br /> signieu this Service Acknvwledga:smt is duly aathor;ced to sign and
<br /> bind Custwner. The.fallowing prevision is applicable Lo Safety-Kleen's
<br /> MLs'Llatluter and paint Ban cleaner avrvico: Cas Lamar agreas Llat it
<br /> l .,..1 .;. .Sx.t uL. .... ;,.i.. tl.. ...:...-J ...i...u,.. ..r.,,.
<br /> solation, ;pd edinyPwithouU liwitatiun any bazardoua waste or - -
<br /> bacardorns waste constituent, except to the extent such introduction is
<br /> iuc;d—Lal L. the a.telal aha ur Use each me. Cuatwuer farther agraea
<br /> that it wd11 not clean parts/poinL guns that have been cuutan;nated
<br /> with or otherwise introduce polychlorinated b.ipbenyls (?CB's).
<br /> LcrLi.iJca, pcaL;.;Jca. J;s;aa .1 I6L.J La.aduua w—L. ;.,Lu LI..
<br /> and is per•mitted`te accept, store, and/or-reclaim the spent parts
<br /> washer solvent; paint Lhinnors, sulvaeLa and paint&Venerated by
<br /> customer; Orrdry c7aan;oV filter cartridges, powder, .rel still
<br /> residwa centaiuiny perchluruelhylones petroleum naphtha, or
<br /> L,Irlw.i.;.7.lr,rei:.ana Jry .leen«Ie e.l rseta. �wiwnn ay,.m that ;i
<br /> is respoubib7is icer properly claaaifying its was la stream as UscJ Oil
<br /> N xd.a..rJ....
<br /> W-1. ;1. . ..Ja... .h» 11,E p.__:.'-' ..r 40 CFR
<br /> 747.11 ars! app!*=a1n1 ttjtr 1:_. C"4l aumt•r agre•rs that it will not
<br /> .atrrJVK a,7 .Y«'.VIIrV,',,.1„g a.La La1..a L.L. LLC SN P,Vp..ty.
<br /> .:UL i; ;Lal; .Ly =,w....J...e ....L. i. J... .a L.
<br /> euustitaant.(;.e., pwlyr.hlorinatad b;phenyls ("PCBs"), herb;c;deb.
<br /> _ - yea*i.;J.a, J;r,.;aa, V," I,atR4 haear ur«a mate.;* ..pi L. Us. .wt.-at
<br /> such introduction is incidental to the normal use of the SK Property.
<br /> In Lhe ereuL .r 1L. L.L—Je.L;.n .r each a.i1-w�,rr. .;ug La..a.orxa
<br /> r.a.t., C—Lwr.c ao1 4 Ut L ;L r.;11 b. ..y.,,.r;4l.,r- .111 -L. —J
<br /> 1.
<br /> Cnp.w..a ........ w w wi y tt
<br /> and disposal of the non-confonuirp wast., incluAng Use cost bf
<br /> a4uipmcri .i-=antas,-a-- --- and ar1.zzyin:tt dizpr fiaal -- -- iy
<br /> will be based on the actual services provided, which may include
<br /> additional charges fur OR sPeeif;catrUa waste and'burcbrrgs. Final
<br />
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