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BRANCH SSL CSG 60 Joseph Lima Jr 02/18/15 12:52 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 400 <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# OR14472 O'Reilly # 3020 65972779 <br /> 309 W Dr Martin Luther Ki SRVC WEEK: 2015-8 <br /> Stockton CA 95206-1705 SRVC DATE: 02/18/15 12:50 <br /> PHONE 972-555-1459 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> OR10217 O'Reilly Auto Parts <br /> 233 S Patterson Ave <br /> Attn Tom Seboldt <br /> Springfield MO 65802-2210 <br /> PHONE 972-265-2485 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 22559 DIY OIL 220 GALLONS TANK 1.000 <br /> SIN 576324 TAG T0002236XX00356309 <br /> SERVICE TERM 2 WEEK SCANNED NO <br /> 66668 DO-IT-YOURSELF OIL SERVIC 165.000 <br /> SERVICE TERM 1 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS <br /> TOTAL CHARGE <br /> CREDITS <br /> --------------- <br /> TOTAL DUE <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT <br /> If high risk source, SK rep. certifies that load specific PCB & <br /> Silicon testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> CESQG: Vehicle <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 and (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/material. 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 SK, 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 authorized 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 /> solution, including without limitation any hazardous waste or <br /> hazardous waste constituent, except to the extent such introduction is <br /> incidental to the normal use of the machine. Customer further agrees <br /> O R14472_SS_65972779 20 <br />