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CSG SK-SSL-BOX-23 Raymond Gomez 12/12/18 14:21 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# DT9721 Dte Stockton Llc 78669697-1806223298 <br /> 2526 W Washington St SRVC WEEK: 2018-50 <br /> Stockton CA 95203-2952 SRVC DATE: 12/12/18 <br /> PHONE 209-479-9315 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> DT9721 Dte Stockton Llc <br /> 2526 W Washington St <br /> Stockton CA 95203-2952 <br /> PHONE 209-479-9315 <br /> PURCHASE ORDER# 4701282661 TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 90837 MODEL 90 W/2387 & 6365 1.000 99.0000 8.91 107.91 <br /> S/N 17030262 TAG 00001170SK17030262 CLEAN 2.50 SPENT 0.000 <br /> SERVICE TERM 8 WEEK Placement SCANNED NO <br /> 100030 RECOVERY FEE 1.000 16.0000 1.44 17.44 <br /> 10042 FEE, INSTALL MDL 90,91,94, 216 1.000 174.0000 15.66 189.66 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 289.0000 26.01 315.01 <br /> TOTAL CHARGE 315.01 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 315.01 <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT 315.01 <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 (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 (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 />