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CSG SK-SSL-BOIL-23 Raymond Gomez 09/26/17 15:59 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2640 N Central Expy, Suite 200 <br /> Richardson, TX 75060 <br /> CORPORATE: e00-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 iSafety-Kleen) <br /> 2095451011 <br /> REFERENCE NfiR, <br /> CUSTOMER# LK00044 Lkq 74706143-1704477962 <br /> 2041 Navy Or SRVC WEEK: 2017-39 <br /> Attn Jerry SRVC DATE; 09/26/17 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> BILL TO CUSTOMER# BILL TO ADDRESS! <br /> LK00044 Lkq <br /> 2041 Navy Or <br /> Attn ,Terry <br /> Stockton CA 95206-•1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ORDER# TAX EXEMPTR <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 w/2387 6 5365 1.000 373.0600 33.58 406.64 <br /> SIN 118982 TAG T0000000XX90209571 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.8100 0.97 11.80 <br /> - -__-__------_---------------------------- <br /> TOTAL SERVICE/PRODUCTS 3B3.8900 31.55 418.44 <br /> TOTAL CHARGE 418.44 <br /> CREDITS 0.00 <br /> TOTAL DUE 418.44 <br /> ------------ <br /> UNPAID BALANCE THIS RECEIPT 418.44 <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/manth <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 {af the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> any 5K agreement signed by Customer and SK, and 12) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, 5K 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 (1) 1.5% per month (186 per annum) or <br /> {ii) the maximum amount allowed by law, will be added to all unpaid <br />