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BRANCH SSL CSG 24 Anthony Romero 02/17/15 12:11 PAGE 1 <br /> Safety-Kleen systems, Inc. <br /> 2600 N Central Expy, Suite 400 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5744 <br /> 24 HR EMERGENCY: 800-468-1750 (Safety-Kleen} <br /> 209$451011 <br /> REFERENCE NBR. <br /> CUSTOMER# LK00044 Lkq 66034834 <br /> 2041 Navy Dr SRVC WEEK: 2015-8 <br /> Attn Jerry SRVC DATE: 02/17/15 12:09 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> BILL Ta CUSTOH£R4 BILL TO ADDRESS, <br /> L900044 Lkq <br /> 2041 Navy Dr <br /> Attn Jerry <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ORDER# TAX EKEMPTO <br /> PRODUCTISERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY SINIT PRICE TAX CHARGE <br /> 90817 MODEL 90 w/2381 & 6365 1.000 316.0500 28.44 344.49 <br /> SIN 118982 TAG TOOU0000KX90209571 CLEAN 3,00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.Ono 12.4600 1.12 13.$0 <br /> --------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 328.5300 29.56 358.09 <br /> TOTAL CXARGE 358.09 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 358.09 <br /> UNPAID BALANCE THIS RECEIPT 358.09 <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 /> Customer certifies that M 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 and (iil no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the wastelmatarlal. Customer agrees to pay the above <br /> charges and to be bound by the terms and conditions (1) set forth in <br /> (a) the General Terms and Conditions provided separately to Customer <br /> or (b) any SK agreement signed by Customer and SX, and (2) <br /> incorporated herein by reference. Unless otherwise indicated in the <br /> payment received section, SK is authorized to charge Customer's <br /> account for this transaction. Customer certifies that the individual <br /> signing this Service Acknowledgement is duly authorised to sign and <br /> bind Customer. The following provision is applicable to Safety-Kleen's <br /> parts cleaner and paint gun cleaner services; Customer agrees that it <br /> will not introduce any substance into the solvent or aqueous cleaning <br />