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SG SK-SSL-VAC-42 Benjamin D Taylor Y 10/08/18 16:54 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 NCentral Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> CUSTOMER# JC10836 JC Trucking Inc REFERENCE NUR. <br /> 1415 W. Anderson St. 78106334-1805049312 <br /> Stockton CA 95206-0000 SRVC WEEK: 2018-41 <br /> PHONE 209-466-3282 SRVC DATE: 10/08/18 <br /> BILL TO CUSTOFIER# BILL TO ADDRESS: <br /> JC10836 JC Trucking Inc <br /> 1415 W. Anderson St. <br /> Stockton CA 95206-0000 <br /> PURCHASE ORDER# PHONE 209-466-3282 <br /> SERVICE/ PRODUCT/SERVICES TAX EXEMPT# <br /> PRODUCT TOTAL <br /> QTY <br /> 66667 VACUUM LIQUID (NON-PQUAL) 880.000IT PRICE TAX CHARGE <br /> SERVICE TERM 26 WEEK 0.0000 0.00 0.00 <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: ppM < 1000 <br /> VAC PH TEST: 6 <br /> 66677 VACUUM SOLID (JON-PQUAL) 720.000 0.0000 0.00 <br /> SERVICE TERM 26 WEEK 0.00 <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> VAC PH TEST: 6 <br /> # CONTS: 1 TSDF: EVG MANIFEST#: 06334 <br /> FORM CNT#: 181008215052 QTY: 1600 WT/VOL G PROF#C156097SH P# 226656917 <br /> SKDOT 3299 <br /> 10967 VAC SERVICE FEE AUTOMOTIV <br /> SERVICE TERM 26 WEEK 1.000 456.0000 0.00 456.00 <br /> 821 DEGREASER, HEAVY DUTY 5 G <br /> SERVICE TERM 24 WEEK 3.000 51.0000 13.77 166.77 <br /> 100030 RECOVERY FEE <br /> 10905 VAC SVS SERVICEFEE 5 1.000 81.0000 7,20 88 29 <br /> 10913 VAC TRUCK WASH 1.000 433.0000 0.00 433.00 <br /> 82118HALOGENS TEST 1.000 300.0000 0.00 300.00 <br /> SOLIDS 1.000 120.0000 0.00 120.00 <br /> 10975 FEE, VAC TES <br /> 1600.000 1.6800 0.00 2688.00 <br /> TOTAL SERVICE/PRODUCTS -----------1442.6800--------- <br /> '---- --- <br /> 21.06 4252.0 <br /> - .0 <br /> ZS2 <br /> 4---- -- <br /> 6 <br /> TOTAL CHARGE 4252.06 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 4252.06 <br /> UNPAID BALANCE THIS RECEIPT <br /> 4252.06 <br /> Per BOG M420-001 the halogen detecting instrument has been <br /> zeroed and validated. <br />'ENERATDR STATUS <br />:ESQG: Vehicle <br />:ustomer certifies that (i) the above-named materials are properly <br /> A assified, packaged, marked and labeled, and are in proper condition <br />:or t ransportation according to the applicable regulations of the <br /> iepartment of Transportation (ii) no material change has occurred <br /> ither in the characteristics of the waste/material or in the process <br /> enerating the waste/material, and (iii) the above referenced <br /> eneretor Status is correct. Customer agrees to pay the above charges <br /> nd to be bound by the terms and conditions (1) set forth in (a) the <br /> eneral Terms and Conditions provided separately to Customer or (b) <br /> 11 SK agreement signed by Customer and SK, and (2) incorporated <br /> ere in by reference. Unless otherwise indicated in the Payment <br /> ace ived section, SK is authorized to charge Customer's account for <br /> his transaction. If Customer fails to make payment when due, an <br /> nount 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 />:ounts outstanding. Customer certifies that the individual signing <br /> its Service Acknowledgement is duly authorized <br /> is tome r. Customer sign and bind <br /> acknowledges that it is to signing <br /> for maintaining <br /> s Generator Status and obtaining an EPA ID number if required by <br /> placable law. The follnwinn <br />