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CSG SK-SSL-BOX-25 Bruce Maeberry 06/14/17 16:21 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# LI20107 Lithia Stockton Nissan Kia 73783199-1702585725 <br /> 3077 Hammer Ln SRVC WEEK: 2017-24 <br /> Stockton CA 95212-0000 SRVC DATE: 06/14/17 <br /> PHONE 209-956-6500 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> LI20104 Lithia Motors <br /> PO Box 1148 <br /> Medford OR 97501-0000 <br /> PHONE 999-999-9999 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 26730 MODEL 26 W/STAND 6365 1.000 91.0000 8.19 99.19 <br /> SIN 14112210 TAG 00001112SK14112210 CLEAN 0.25 SPENT 0.000 <br /> SERVICE TERM 4 WEEK SCANNED YES <br /> 905837 MODEL 90.5 W/2387 6365 10 1.000 161.8700 14.57 176.44 <br /> SIN 15918230 TAG 00002697SK15918230 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 4 WEEK SCANNED YES <br /> 100030 CHARGE, MISC - FUEL 1.000 25.2900 2.28 27.57 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 278.1600 25.04 303.20 <br /> TOTAL CHARGE 303.20 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 303.20 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 303.20 <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 (18% per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br />