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CSG SK-SSL-BOX-24 Steve Mullan 05/25/17 14:03 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# RA24640 Rail Terminal Services 73587070-1702104060 <br /> 1000 E Roth Rd SRVC WEEK: 2017-21 <br /> French Camp CA 95231-0000 SRVC DATE: 05/25/17 <br /> PHONE 209-546-7279 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> RA24640 Rail Terminal Services <br /> 1000 E Roth Rd <br /> French Camp CA 95231-0000 <br /> PHONE 209-546-7279 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 905837 MODEL 90.5 W/2387 6365 10 1.000 215.0000 16.66 231.66 <br /> SIN 15918153 TAG 00002697SK15918153 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 8 WEEK SCANNED YES <br /> 3383 DRUM,55 GAL FOR O.F. 1.000 10.0000 0.00 10.00 <br /> SERVICE TERM 12 WEEK <br /> 83383 DRUM,55 WASTE O.F. 1.000 80.0000 0.00 80.00 <br /> SERVICE TERM 12 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.8300 0.84 11.67 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 1.000 0.0000 0.00 0.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 315.8300 17.50 333.33 <br /> TOTAL CHARGE 333.33 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 333.33 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 333.33 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly 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 /> Local Phone No. Sticker Affixed to Machine Yes <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 lbs/month <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 />