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CSG SK-SSL-BOX-23 Gomez,Raymond 08-11-2022 09:54 PAGE 1 V-6.9 <br /> Safety-Kleen Systems, Inc. <br /> 42 Longwater Drive <br /> Norwell, MA 02061 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSTOMER# OR14461 O'Reilly # 2917 89713184 - 2110638523 <br /> 3228 E Hammer Ln SRVC WEEK: 2022-32 <br /> Stockton SRVC DATE: 08-11-2022 <br /> CA 95212-2814 <br /> PHONE 972-555-1370 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> OR10217 O'Reilly Auto Parts <br /> 233 S Patterson Ave <br /> Attn John Bounds <br /> Springfield <br /> MO 65802-2210 <br /> PHONE 417-520-4589 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/PRODUCT QTY UNIT PRICE TAX TOTAL CHARGE <br /> 706 PAIL, 5 GL BLACK POLY W/SCREW ON LID 1.0 TIER1 TIER1 TIER1 <br /> 3302 PAIL 5 GL BLACK STEEL W/LID & RING OH 0 TIER1 TIER1 TIER1 <br /> CAUSE CODE VOIDHEADERANDLINE -SERVICE NOT NEEDED <br /> 875453/ 645151 CHP-SLD OR SEMI-SLD TO HAZ LF 5GL 2.0 TIER1 TIER1 TIER1 <br /> SERVICE TERM 24 WEEK <br /> CONT#: 2 TSDF:SJ MANIFEST#: FORM CD:US SHIP#: 237795840 <br /> 008561970SKS <br /> CNT#: 220810958983 QTY: 30 WT/VOL P PROF#:645151 SKDOT#: 9460986 <br /> CNT#: 220810958982 QTY: 30 WT/VOL P PROF#:645151 SKDOT#: 9460986 <br /> 100001 FEE, FUEL SURCHAR 1.0 TIER1 TIER1 TIER1 <br /> 100065 E-Manifest Fee 1.0 TIER1 TIER1 TIER1 <br /> TOTAL SERVICE/PRODUCTS <br /> TIER1 TIER1 TIER1 <br /> TOTAL CHARGE TIER1 <br /> CREDITS TIER1 <br /> ------------------------------ <br /> TOTAL DUE TIER1 <br /> ------------------------------ <br /> UNPAID BALANCE THIS RECEIPT TIER1 <br /> GENERATOR STATUS <br /> 0-220 lbs/month <br /> Customer certifies that (i) the I have established a program to reduce the volume above-named materials are properly or <br /> quantity and toxicity of the hazardous waste classified, packaged, marked and to the degree to be economically <br /> practicable. labeled, and are in proper condition for transportation according to the applicable regulations of the <br /> Department of Transportation (ii) no material change has occurred either in the characteristics of the waste/material or <br /> in the process generating the waste/material, and (iii) the above referenced Generator Status is correct. Customer agrees <br /> to pay the above charges and to be bound by the terms and conditions (1) set forth in (a) the General Terms and <br /> Conditions provided separately to Customer or (b) any SK agreement signed by Customer and SK, and (2) incorporated herein <br /> by reference. Unless otherwise indicated in the payment received section, SK is authorized to charge Customers account <br /> for this transaction. If Customer fails to make payment when due, an amount equal to the lesser of (i) 1.5% per month <br /> (18% per annum) or (ii) the maximum amount allowed by law, will be added to all unpaid amounts outstanding. Customer <br /> certifies that the individual signing this Service Acknowledgement is duly authorized to sign and bind Customer. Customer <br /> acknowledges that it is responsible for maintaining its Generator Status and obtaining an EPA ID number if required by <br />