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CSG SK-SSL-BOX-24 Shane Allen 09/20/IB 11;33 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 /> CUSTOMERA TR34020 Tracy Nissan 77789593-1B04367719 <br /> 3195 Naglee Rd SRVC WEEK: 2018-38 <br /> Tracy CA 95304-7319 SRVC DATE: 09/20/16 <br /> PHONE 510-235-7979 <br /> BILL TO CUSTOMER$ BILL TO ADDRESS: <br /> TR34020 Tracy Nissan <br /> 3195 Naglee Rd <br /> Tracy CA 95304-7319 <br /> PHONE 510-235-7979 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 83383 DRUM,55 WASTE O.F. 2.000 25.0000 0.00 50.00 <br /> SERVICE TERM 12 WEEK <br /> 3383 DRUM,55 GAL FOR O.F. 2.000 5.0000 0.00 10.00 <br /> SERVICE TERM 12 WEEK <br /> 26730 MODEL 26 W/STAND 6365 1.000 65.0000 5.36 70.36 <br /> SIN 13112171 TAG 00001112SX13112171 CLEAN 0.25 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 90837 MODEL 90 W/2367 s 6355 1.000 109.0000 6.99 117.99 <br /> SIN 13130234 TAG 00001170SK13130234 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br /> 3230 TAX HANDLING NIC DRUM DROP 30 2.000 0.0000 0.00 0.00 <br /> --------------------------------------- - <br /> TOTAL SERVICE/PRODUCTS 204.0000 14.35 248.35 <br /> TOTAL CHARGE 248.35 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 248.35 <br /> UNPAID BALANCE BALANCE THIS RECEIPT 248.35 <br /> Machine clean and goad 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 Drovided separately to Customer or (b) <br /> any SK agreement signed by Customer and SK, and (2) incorporated <br />