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GENERATOR STATUS CfSQG: Vehicle CSG SK-SSL-UMO-01 Joseph R Lima Jr 01/23/19 08:43 PAGE 1 Customer certifies that (i) the above-name) materials are properly classified, packaged, marked and labeled, and are in proper condition �' for transportation according to the applicable regulations of the S a fe t Y—M e e n S y s t em s � nz ' Department of Transportation (ii) no material change has occurred 2600 N Central Expy, Suite 200 either in the characteristics of the waste/material or in the process Richardson. TX 75080 generating the waste/material, and (iii) the above referenced CORPORATE: 800-669-5740 Generator Status is correct. Customer agrees to pay the above charges 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) and to be bound by the terms and conditions (1) set forth in (a) the 2495451011 General Terms and Conditions provided separately to Customer or (b) REFERENCE NOR. any SK agreement signed by Customer and SK, and (2) incorporated CUSTDMER# 0079848 Ingredion Inc 79077628-1900395214 herein by reference. Unless otherwise indicated in the payment 1021 Industrial Dr SRVC WEEK^ 2419-4 received section. SK is authorized to charge Customer's account for Stockton CA 95206-3928 !�FjW DATE: 01/23/" this transaction. If Customer fails to make payment when due, an PHONE 209-S47-8233 amount equal to the lesser of Ci q ) 1.5% per month (1896 per annum or BILL TO CUSTOMER# BILL TO ADDRESS: (ii) the maximum amount allowed by law, will be added to all unpaid C080437 Ingredion Inc amounts outstanding. Customer certifies that the individual signing 810 S. Cincinnati Ave this Service Acknowledgement is duly authorized to sign and bind Tulsa OK 74119-0000 Customer. Customer acknowledges that it is responsible for maintaining PHONE 209-982-I920 its Generator Status and obtaining an EPA ID number if required by PURCHASE ORDER# roger, hoffdahl TAX EXEMPT# applicable law. The following provision is applicable to PRODUCT/SERVICES Safety-Klaen's parts cleaner and paint gun cleaner services: Customer agrees that it will not introduce any substance into the solvent or SERVICE/ TOTAL aqueous cleaning solution, including without limitation any hazardous PRODUCT 4TY UNIT PRICE TAX CHARGE waste or hazardous waste constituent, except to the extent such ,;,{36 USED OIL RECYCLE Ati-'0VU?Z 205.000 0.5900 0.00 120.95 introduction is incidental to the normal use of the machine, Customer SERVICE TERM 12 WEEK further agrees that it will not clean parts/paint guns that have been HALOGEN / CLOR-D-TEcr IE�,T RESULT PASS: PPM < 1000 contaminated with or otherwise introduce polychlorinated biphenyls (PCB's), herbicides, pesticides, dioxins or listed hazardous waste 10256 FEE. OIL SERVICE/STOP NON 1.000 215.0000 0.00 215.40 into the solvent or aqueous cleaning solution. Safety-Kleen has the SERVICE TERM 12 WEEK capacity and is permitted to accept, store, and/or reclaim the spent ----------------------------------------- parts washer solvent; paint thinners, solvents and paints generated by TOTAL SFRVICE/PRODUCTS 215.5900 0.00 335.95 customer; or dry cleaning filter cartridges, powder, and still residues containing perchloroethyiene, petroleum naphtha, or TOTAL CHARGE 33S.95 triflurotrichloroethane dry cleaning solvents. Customer agrees that it CREDITS 0.00 is responsible for properly classifying its waste streams as Used Oil --------------- or Nonhazardous Waste in accordance with the provision of 40 CFR TOTAL DUE 335.95 262.11 and applicable state laws. Customer agrees that it will not introduce any non-conforming substance into the SK Property, including, without limitation, any hazardous waste or hazardous waste UNPAID BALANCE THIS RECEIPT 335.95 constituent,(i.e., polychlorinated biphenyls C'°PCBs"), herbicides, pesticides, dioxins, or listed hazardous wastes) except to the extent such introduction is incidental to the normal use of the SK Property. In the event of the introduction of such non-conforming hazardous waste. Customer agrees that it will be responsible for all casts and remediation expenses related to or arising from the proper management and disposal of the non-conforming waste, including the cost of equipment decontamination and subsequent disposal. Final invoicing If high risk source, rep. certifies that load specific PCB a silicon will be based on the actual services provided, which may include testing have been completed prior to pumping this load. additional charges for off specification waste and surcharges. Final invoice amount may be more than the amount listed on the printed receipt. If any legal action is commenced because of an alleged dispute, breach, default or misrepresentation, the Customer also Aarees that the n" '1; N � w cmN u dry a W W W 1 h LLJ O N ~ pp � li si m CL 7 m Q, gWg w a J .G M ylI,,Il`Vl m 11,o C F_ n 0 O N N4 N��dl .. Z �� H 0IZj• •- N Y c IL 4 p�p �" a V I n p G Z V e O S M 2 O J �O C ••W N J VZ1 N aO V _p � •� � VI J u Z v Y a " o CL J COI+S•�pW D: C O kA C N CL ¢ t•I..ve o:h u_zL a o-i 7 vl �d V m vS V C' W h W = z ro a n Q J }m gQ a°pSe L 71 fI�J V Q Y CO ZI/� O F ry II...{� Q Z.-I Z H a v II�J V O O V 3 N J q l O O C V q IAN 46 Y�Y Z Z I,'o•. Io�y-1 o In V Fj n OR c H W C C n r G V X p W 0CL G N O.•I V{Wu�H � w� F u V1 Z.i I�y,I Y N V Z 4 Vl W C p W 1' r� a7 4 N C O } Z 0 Q } W F NCS O Q O J 3 V Q}V 1 Y x [^F :I LA W f g W kA a 0 V Q # Z F �• J D`li I IAS O 6 W N IA O I r F W Fi g O W W F p�Z Htt 003��I MCF�I W Ct i V Z LA M V 17 � i- 2�-'tWi l~/I F V BNmZ~ LL t4i V V V— V Signature TRANSPORTER: Joseph R Lima Jr