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CSG SK-SSL-HOX-23 David L Buxton 04/13/16 15:20 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 809-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE HSR. <br /> CUSTOMER# LK00044 Lkq 69847278 <br /> 2041 Navy Or SRVC WEEK: 2016-16 <br /> Attn Jerry SRVC DATE; 44/13/16 15:18 <br /> Stockton CA 95206-1142 <br /> PHONE 209-464-1111 <br /> SILL TO CUSTOMERS HILL TO ADDRESS: <br /> LK00044 Lkq <br /> 2041 Navy Or <br /> Attn Jerry <br /> Stockton CA 95206-1142 <br /> PHONE 209-464--1111 <br /> PURCHASE ORDER4 TAX EXEMPT6 <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 W/2387 & 6365 1.000 335.0000 30.15 365.15 <br /> S/14 118982 TAG T000000OXX902095'71 CLEAN 3.00 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 100091 FEE, FUEL SURCHARGE 1.000 8.9000 0.80 9.70 <br /> ---------------------- <br /> TOTAL SERVICEJPRODUCTS 343.9000 30.95 374.85 <br /> TOTAL CHARGE 374.85 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 374.85 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 374.85 <br /> Machine clean and goad 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 fit 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 Iii) 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 1a) 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 Customerls account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (188 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 />