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CSG SK-SSL-BOX-23 Gomez,Raymond 12-22-2021 09:53 PAGE 1 V-6.1 Safety-Kleen Systems, Inc. 42 Longwater Drive Norwell, MA 02061 CORPORATE: 800-669-5740 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) 2095451011 REFERENCE HER. CUSTOMER# OR14472 O'Reilly # 3020 87972582 - 2106454989 309 W Dr Martin Luther King Jr Blvd SRVC WEEK: 2021-51 Stockton SRVC DATE: 12-22-2021 CA 95206-1705 PHONE 209-462-5690 BILL TO CUSTOMER# BILL TO ADDRESS: OR10217 O'Reilly Auto Parts 233 S Patterson Ave Attn John Bounds Springfield MO 65802-2210 PHONE 417-520-4589 PURCHASE ORDER# TAX EXEMPT# PRODUCT/SERVICES SERVICE/PRODUCT QTY UNIT PRICE TAX TOTAL CHARGE 8003369 DRUM, 55 GL BLACK STEEL OH RECON 1.0 TIER1 TIER1 TIER1 875460/ 40559605 CNO-NON HAZARDOUS SOLID 55GL 1.0 TIER1 TIER1 TIER1 SERVICE TERM 48 WEEK CONT#: 1 TSDF:GM MANIFEST#: FORM CD:US SHIP#: 236000903 008119761SKS CNT#: 211221728673 QTY: 200 WT/VOL P PROF#:40559605 SKDOT#: 7361257 100001 FEE, FUEL SURCHARGE 1.0 TIER1 TIER1 TIER1 TOTAL SERVICE/PRODUCTS TIER1 TIER1 TIER1 TOTAL CHARGE TIER1 CREDITS TIER1 ------------------------------ TOTAL DUE TIER1 ------------------------------ UNPAID BALANCE THIS RECEIPT TIER1 GENERATOR STATUS 0-220 lbs/month Customer certifies that (i) the I have established a program to reduce the volume above-named materials are properly or quantity and toxicity of the hazardous waste classified, packaged, marked and to the degree to be economically practicable. labeled, and are in proper condition for transportation according to the applicable regulations of the Department of Transportation (ii) no material change has occurred either in the characteristics of the waste/material or in the process generating the waste/material, and (iii) the above referenced Generator Status is correct. Customer agrees to pay the above charges and to be bound by the terms and conditions (1) set forth in (a) the General Terms and Conditions provided separately to Customer or (b) any SK agreement signed by Customer and SK, and (2) incorporated herein by reference. Unless otherwise indicated in the payment received section, SK is authorized to charge Customers account for this transaction. If Customer fails to make payment when due, an amount equal to the lesser of (i) 1.5% per month (18% per annum) or (ii) the maximum amount allowed by law, will be added to all unpaid amounts outstanding. Customer certifies that the individual signing this Service Acknowledgement is duly authorized to sign and bind Customer. Customer acknowledges that it is responsible for maintaining its Generator Status and obtaining an EPA ID number if required by applicable law. The following provision is applicable to Safety-Kleens parts cleaner and paint gun cleaner services: Customer agrees that it will not introduce any substance into the solvent or aqueous cleaning solution, including without limitation any hazardous waste or hazardous waste constituent, except to the extent such introduction is incidental to the normal use of the machine. Customer further agrees that it will not clean parts/paint guns that have been contaminated with or otherwise introduce polychlorinated biphenyls (PCBs), herbicides, pesticides, dioxins or listed hazardous waste into the solvent or aqueous cleaning solution. Safety-Kleen has the capacity and is permitted to accept, store, and/or reclaim the spent parts washer solvent; paint thinners, solvents and paints generated by customer; or dry cleaning filter cartridges, powder, and still residues containing perchloroethylene, petroleum naphtha, or triflurotrichloroethane dry cleaning solvents. Customer agrees that it is responsible for properly classifying its waste streams as Used Oil or Nonhazardous Waste in accordance with the provision of 40 CFR 262.11 and applicable state laws.