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CSG Sk-SSI.-BOX-23 Raymond Gomez 11/19/18 15:17 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75060 <br /> CORPORATE: 860--569-5140 <br /> 24 HR EMERGENCY: 800-468-1760 ]Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# LK00044 Lkq 78339652-1805514251 <br /> 2041 Navy or ERVC WEEK: 2018-47 <br /> Attn Jerry SRVC DATE: 11/19/18 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> HILL TO CUSTOMER# BILL TO ADDRESS: <br /> LKOD044 Lkq <br /> 2041 Navy or <br /> Atto Jerry <br /> Stackton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> PURCRASE ORDERR TAH EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90937 MODEL 90 W/2387 & 6365 1.0001 336.0000 30.24 356.24 <br /> SIN 118982 TAG TO000000XX90209571 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED NO <br /> 100030 RECOVERY FEE 1.000 31.9200 2.81 34.79 <br /> ----------------------------------------- <br /> TOTAL SERVICEIPRODUCTS 367.9200 33.11 401.03 <br /> TOTAL CHARGE 40.1.03 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 401.03 <br /> UNPAID BALANCE THIS RECEIPT 401.03 <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 Yea <br /> Spent solvent meets acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that W 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 (it] no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material, and (iiiy 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 falls to make payment when due, an <br /> amount equal to the lesser of )i) 1.50 per month (18% per annum) or <br /> )ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br />