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CSG SX-SSL-BOX-23 WiluKr Garcia Garcia 09/28/17 16:29 PALE 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 EMERGEcv: 800-468-1760 (Safety-kleen) <br /> 2095451031 <br /> REFERENCE PM <br /> CUSTDHtI(+ UI05988 utility Trailer 74906278-1704899597 <br /> 12608 S Harlan Rd SRVC WEEk: 2017-40 <br /> Lathrop CA 95330-8744 SRVC DATE: 09/28/17 <br /> PHONE 209-444-8800 <br /> HILL TO (USFDMF" BILL TO ADDRESS: <br /> UTD5988 Utility Trailer <br /> 12608 S Harlan Rd <br /> Lathrop CA 93330-8744 <br /> PHONE 209-444-8800 <br /> PURCHASE ORDERS 6215 TAX EXEMPTS <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODt1CT QTY UNIT PRICE TAX CHARGE <br /> 3383 DRUM.S5 GAL FOR O.F. 2,000 21.2000 O.DD 42.40 <br /> SERVICE TERM 24 WEEK <br /> Y <br /> 8;383 DRUN,55 WASTE O.F. 2.000 108.1600 0.00 214.32 <br /> SERVICE TERM 24 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.9300 0,00 10.83 <br /> 3230 TAX HANDLING N/C DRUM DROP 10 2.000 0.000 0.00 0.00 <br /> ------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 140.1900 0.00 269,55 <br /> TOTAL CHARGE 268.55 <br /> CREDIT$ 0.00 <br /> TOTAL DUE 269.S5 <br /> UNPAID BALANCE THIS RECEIPT 269,S5 <br /> Sf{lna[ure <br /> CUSTOMER /GENERATOR: andre kimball <br /> SlgmtLre <br /> TRANSPORTER: Wilmer Garcia Garcia <br /> CSG SK-SSL-BOX-23 Wilmer Garcia Garcia 09/28/17 16:29 PAGE 2 <br /> SHIPPING DOCUMENT <br /> REFFRENCE NRR. <br /> CUSTOME9*/6ENEHATDR: U105936 Utility Trailer 74906278-1704899597 <br /> 12608 5 Harlan Rd <br /> Lathrop CA 95330-8744 <br /> PHONE 209-444-8800 <br /> GEINLRAIOR USLPA 10. CALOOO289727 GENERATOR STATE 90(j0019999 <br /> HAHIFEST#: DO610958SKS FORM CTT: 1D SNAPS 223557640 <br /> TRANSPORTER 1 I-M0000812GS SAFETY-KLEENY SYSTEMS, INC, <br /> $050 SALIDA BLVD <br /> SALTDA,CA. 9S366 <br /> TNSP PHONE: 209-S45-1011 <br /> TRANSPORTER 2 <br /> US DOT UE!.CHIPfION [INCLUDING PROPER SHIPPING NAME, IWARD CLASS, AND I0) <br /> 1 <br /> - HON•RCRA HAZARDOUS WASTE, SOLID , <br /> CDRAINEDfUFARAINED USED OIL FILTERS) <br /> FEDERAL WASTE CODES NONE <br /> STATE WASTE CODES <br /> TOTAL CONT 2 TYPE DM WT/VOL P 5KOOT 7872576 <br /> CNT1: 170925830348 SZ: 55 GAL/205 L CONTAINERS QTl': 400 PHOTS 156033 C <br /> CNT1: 170926836350 SI: 5S GAL/205 L CONTAINERS QTY: 400 PROF* 156033 C <br /> DESIGNATED FACILITY NAME/ADDRESS: <br /> THEM FLUIDS INC <br /> I2S33 SE CARPENTER OR <br /> CLACKAMAS OR 97015-8988 <br /> TSD PHONE: 503-788-4616 <br /> FACILITY USEPA ID NO ORQOWOZSI97 <br />