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CSG SK-SSL-UMO-01 Joseph R Lima Jr 12/18/17 <br />11:12 PAGE 1 <br />Safety-Kleen Systems, Inc. <br />2600 N Central Expy, Suite 200 <br />Richardson, TX 75080 <br />CORPORATE: 800-669-5740 <br />24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br />2095451011 <br />REFERENCE NBR. <br />CUSTOMER# T029125 Tower Park Marina <br />75645234 <br />14900 W Highway 12 SRVC <br />WEEK: 2017-51 <br />Lodi CA 95242-9514 SRVC <br />DATE: 12/18/17 <br />PHONE 510-834-4591 <br />BILL TO CUSTOMER# BILL TO ADDRESS: <br />SA32681 County of San Joaquin DPW/Solid Waste <br />1810 E Hazelton Ave <br />Stockton CA 95205-6232 <br />PHONE 909-947-9363 <br />PURCHASE ORDER# 12-18-17 <br />TAX EXEMPT# <br />PRODUCT/SERVICES <br />SERVICE/ <br />TOTAL <br />PRODUCT QTY UNIT PRICE TAX <br />CHARGE <br />10256 FEE, OIL SERVICE/STOP NON 1.000 145.0000 <br />0.00 145.00 <br />SERVICE TERM 24 WEEK <br />66636 USED OIL RECYCLE AUTOMOTI 210.000 0.3900 <br />0.00 81.90 <br />SERVICE TERM 24 WEEK <br />HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br />----------------------------------------- <br />TOTAL SERVICE/PRODUCTS 145.3900 <br />0.00 226.90 <br />TOTAL CHARGE <br />226.90 <br />CREDITS <br />0.00 <br />TOTAL DUE <br />--------------- <br />226.90 <br />--------------- <br />UNPAID BALANCE THIS RECEIPT 226.90 <br />If high risk source, rep. certifies that load specific PCB & Silicon <br />testing have been completed prior to pumping this load. <br />GENERATOR STATUS <br />CESQG: Vehicle <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 (ii) no material change has occurred <br />either in the characteristics of the waste/material or in the process <br />generating the waste/material, and (iii) the above referenced <br />Generator Status is correct. Customer agrees to pay the above charges <br />and to be bound by the terms and conditions (1) set forth in (a) the <br />General Terms and Conditions provided separately to Customer or (b) <br />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 <br />this transaction. If Customer fails to make payment when due, an <br />amount equal to the lesser of (i) 1.5% per month (18% per annum) or <br />(ii) the maximum amount allowed by law, will be added to all unpaid <br />amounts outstanding. Customer certifies that the individual signing <br />this Service Acknowledgement is duly authorized to sign and bind <br />Customer. Customer acknowledges that it is responsible for maintaining <br />its Generator Status and obtaining an EPA ID number if required by <br />applicable law. The following provision is applicable to <br />Safety-Kleen's parts cleaner and paint gun cleaner services: Customer <br />agrees that it will not introduce any substance into the solvent or <br />Page 16 <br />