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CSG SK-SSL-BOX-23 Raymond Gomez 07/27/16 12:00 PAGE 1 <br /> Safety-Meen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75060 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NSR. <br /> CUSTOMER# LK00044 Lkq 70597796 <br /> 2041 Navy Dr SRVC WEEK: 2016-28 <br /> Attn Jerry SRVC ITATE: 07/27/16 11:58 <br /> Stockton CA 95206-1142 <br /> PHONE 299-464-1111 <br /> SILL TO CUSTOMER4 BILI, TO ADDRESS: <br /> LK0 0044 Lkq <br /> 2041 Navy Or <br /> Attn Jerry <br /> Stockton CA 95206.1142 <br /> PHONE 209-464-1111 <br /> PURCHASE ORDER# TAX EXEMPTO <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE: TAX CHARGE <br /> 90837 MODEL 90 W/2387 & 6365 1.000 345.0500 31.05 376.10 <br /> SIN 118982 TAG T000060OXX90209571 CLEAN 3.00 SPENT 0.000 <br /> SERVICE TERN 12 WEEK SCANNED YES <br /> 100001 FEE, FUEL SURCHARGE 1.000 10.1800 0.92 11.10 <br /> TOTAL SERVICE/PRODUCTS 355.2300 31.97 387.20 <br /> TOTAL CHARGE 387.20 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 387.20 <br /> UNPAID BALANCE THIS RECEIPT 387.20 <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 (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 (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. Custwer agrees to pay the above charges <br /> and to be hound 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 fails t❑ make payment when due, an <br /> amount equal to the lesser of (1) 1.59 per month (16% 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 /> this Service Acknowledgement is duly authorized to sign and bind <br />