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CSG SK- SSL-BOX- 23 Raymond Gomez 01 / 08 / 18 11 : 36 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 - 46B - 1760 ( Safety- Kleen ) <br /> 2095451011 <br /> REFERENCE NBR . <br /> CUSTOMER# CH40434 Chrisp Cc 75813400 <br /> 1001 Stokes Ave SRVC WEEK : 2018 - 2 <br /> Stockton CA 95215 - 4023 SRVC DATE : 01 / 08 / 18 <br /> PHONE 209 - 948 - 3038 <br /> BILL TO CUSTOMER# BILL TO ADDRESS : <br /> CH40389 Chrisp Co <br /> 43650 Osgood Rd <br /> Fremont CA 94539 - 5631 <br /> PHONE 410 - 466 - 5700 <br /> PURCHASE ORDER# TAX EXEMPT # <br /> PRODUCT/SERVICES <br /> SERVICE / TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 53830 COMS MDL 53 AQ / 6365 1 . 000 0 . 0000 0 . 00 0 . 00 <br /> SIN 12345 CLEAN 3 . 00 SPENT 0 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidLine -WASTE PICKUP ONLY <br /> TOTAL SERVICE / PRODUCTS 0 . 0000 0 . 00 0 . 00 <br /> TOTAL CHARGE 0 . 00 <br /> CREDITS 0 . 00 '.. <br /> TOTAL DUE 0 . 00 '.. <br /> UNPAID BALANCE THIS RECEIPT 0 . 00 <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 /> 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 ( 18o 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 />