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Safety-Kleen <br /> 00 Legacy Dr. <br /> er Il, Building 3 <br /> Wtro, <br /> Texas 75024 <br /> 209-545-1011 <br /> REFERENCE NRR <br /> CUSTOMER# 2801301 MARTIN BROWER 0026800708 <br /> SERVICE TAX: 0.07750 4704 FITE CT SRVC WEEK: 04-32 <br /> CONS TAX: 0.00000 SRVC DATE: 08/13104 16:43 <br /> PRODUCT TAX: 0.07750 STOCKTON CA 95205 <br /> PHONE 209 946-3748 <br /> PURCHASE OBER# TAX EXEMPTION NBR: <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> SERIAL# <br /> 100009 FUEL FEE SURCHARGE 1 8,1500 0.00 8.15 <br /> 92383 2383 PUMP ASSEMBLY 1 0.0000 0.00 0,00 <br /> 83321195 CLEAN 0 SPENT 0 <br /> SERVICE TERM 8 PREV SERIAL# 83309845 <br /> CAUL CODE 4 <br /> 94830 MODEL 94 W12370/6317 1 157.2500 12.19 169.44 <br /> 94012857 CLEAN 2 SPENT 0 <br /> SERVICE TERM 8 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 165.4000 12.19 177.59 <br /> USEPA TRANSPORTER 1 TXR000060930 GENERATOR USEPA CAL000256206 <br /> USEPA TRANSPORTER 2 GENERATOR STATE <br /> MANIFEST DOC # 23695186 FORM CODE 10 <br /> US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID <br /> USED CLEANING COMPOUNDS, N.O.I.B.N. <br /> LIQUID (NOT USDOT OR USEPA REGULATED) <br /> AQUEOUS PARTS WASHER SOLUTION (8.3#GAL) <br /> TOTAL CONT 1 TYPE OM TTL QTY 12 UNIT WT/VOL G SKOOT 941 <br /> CONTAINER# 40717079390 QTY 12 WASTE CODE CA 134 <br /> DES I(MATED FACILITY NAME/ADDRESS: <br /> SAFETY-KLEEN SYSTEMS, INC. <br /> 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> USEPA ID NO CAT000613%8 TOTAL CHARGE 177.59 <br /> STATE ID NO CAT000613%8 WASTE MIN 0.00 <br /> TOTAL DUE 177.59 <br /> -------------- <br /> AMOUNT PAID CREDIT CARO 177.59 <br /> Mastercard ACCT# 7059 EMP DATE 09/06 <br /> UNPAID BALANCE THIS RECEIPT 0.00 <br /> Machine clean and good 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 /> Spent solvent meets acceptance criteria? Yes <br /> Prop 65 warning (Calf. only)? Yes <br /> GENERATOR STATUS 0 - 220 lbs/month <br /> The generator has established a program to reduce the volume or <br /> quantity and toxicity of the hazardous waste to the degree, as determined <br /> by the generator, to be economically practicable. <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 and (ii) no material change has occurred <br /> either in the characteristics of the waste materials or in the process <br /> generating the waste materials. Customer agrees to pay the above <br /> charges and to be hound by the terms and conditions (1) set forth in (a) <br /> the General Terms and Conditions provided separately to Customer or <br /> (b) 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 this <br /> transaction. Customer certifies that the individual signing this Service <br /> Acknowledgement is duly authorized to sign and bind Customer. <br /> IN THE EVENT OF AN EMERGENCY CALL 1-800-468-1760 (24 hours) <br /> x <br /> SIGNATURE NAME: DEN N I S BAN <br /> -___-e�. <br />