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CSG SK -SSL -BOX -23 <br />Raymond Gomez <br />11/13/18 11:28 PAGE 1 <br />afety® leen 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 />CUSTOMER# DE54220 Delgado Auto <br />101 W Dr Martin Luther Ki <br />Stockton CA 95206-1703 <br />PHONE 760-579-1533 <br />BILL TO CUSTOMER# BILL TO ADDRESS: <br />DE54220 Delgado Auto <br />101 W Dr Martin Luther King Jr Blvd <br />Stockton CA 95206-1703 <br />PHONE 760-579-1533 <br />REFERENCE NBR. <br />78481056 <br />SRVC WEEK: 2018-46 <br />SRVC DATE: 11/13/18 <br />PURCHASE ORDER# TAX EXEMPT# <br />PROD UCT/SEIRAV11C ES <br />SERVICE/ TOTAL <br />PRODUCT QTY UNIT PRICE TAX CHARGE <br />905837 MODEL 90.5 W/2387 6365 10 1.000 0.8100 0.07 0.88 <br />SIN 15918845 TAG 00002697SK15918845 CLEAN 2.50 SPENT 0 <br />SERVICE TERM 4 WEEK Placement SCANNED YES <br />100030 RECOVERY FEE 1.000 16.5000 1.49 17.99 <br />---------------------------------------- <br />TOTAL SERVICE/PRODUCTS 17.3100 1.56 18.87 <br />TOTAL CHARGE <br />CREDITS <br />TOTAL DUE <br />UNPAID BALANCE THIS RECEIPT 18.87 <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 />18.87 <br />0.00 <br />--------------- <br />18.87 <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 Eor <br />