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CSG SK-SSL-BOX-21 Brandon J Gaither 07/13/20 13:48 PAGE 1 <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# OR14365 O'Reilly # 3501 83728609-2003589062 <br /> 515 E Yosemite Ave SRVC WEEK: 2020-29 <br /> Manteca CA 95336-5837 SRVC DATE: 07/13/20 <br /> PHONE 209-239-4188 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> OR10217 O'Reilly Auto Parts <br /> 233 S Patterson Ave <br /> Attn John Bounds <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 /> 829557/ <br /> 870600 LFB1-LP FOR FUELS BLENDIN 1.000 <br /> # CONTS: 1 TSDF: AG MANIFEST#: 007313649SKS FORM CD: US SHIP# 231906568 <br /> CNT#: 200710464703 QTY: 200 WT/VOL P PROF# 829557 SKDOT 7493342 <br /> 3345 DRUM, 30 GL BLACK STEEL 0 1.000 <br /> CAUSE CODE VOIDHEADERANDLINE -SERVICE NOT NEEDED <br /> 8003369 DRUM, 55 GL BLACK STEEL 0 1.000 <br /> SERVICE TERM 24 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 <br /> 100065 E-Manifest Fee 1.000 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS <br /> TOTAL CHARGE <br /> CREDITS <br /> --------------- <br /> TOTAL DUE <br /> --------------- <br /> UNPAID BALANCE THIS RECEIPT <br /> GENERATOR STATUS <br /> 220-2200 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 />