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CleanHarbo[5 <br />March 29, 2017 Page 8 of 10 <br />Clean Harbors Quote #2632717 <br />ACKNOWLEDGEMENT <br />Your signature below indicates your acceptance of the pricing and terms detailed in the quote above, <br />and the Field Services Agreement in the following pages. <br />Thank you for the opportunity to be of service. <br />CUSTOMER'S AUTHORIZED <br />REPRESENTATIVE OR AGENT <br />Signature <br />Print Name <br />Clean Harbors Environmental Services, Inc. <br />Signature <br />Print Name <br />Date Date <br />Phone <br />Purchase Order Number <br />Customer Insurance Carrier <br />0 "People and Technology Creating a Safer, Cleaner Environment"