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. I <br /> CSG SK-SSL-BOX-23 Raynrond Gampa 11/14/18 15:10 PAG! <br /> Safety-Kleen Systems, Inc. <br /> 2000 N Central Expy, Suite 200 <br /> RichaPdson, TX 75080 <br /> COA3+OdA1E:400-669-5740 <br /> 24 MR EMERGENCY: 800-468-1760•(541etY-K1een) <br /> . - zg95451011 <br /> REFERENCE MH <br /> 057OMERB, CA48822 Cal-Trans Shop 10-30110 Nc 78476981-180579372 <br /> 1603 S B St SRVC WEEK: 2018•: <br /> Stockton CA 95206.2476 SRVC DATE: 11/14/1 <br /> PHONE 209-048-7813 <br /> BILL 10 CUSTOMERS BILL TO ADORESsi <br /> CA46822 Cal-Trans Shop 10- 30110 Nc <br /> 1003 S 0 St <br /> Stockton CA 05206-2478 <br /> PHONE 200-048-7813 <br /> PURCHASE ORDER# TAX <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAI <br /> PROEMI T QTY UN1T PRICE TAX CHARGE <br /> 1745975/ <br /> 875460 CNQ-NON HAZARDOUS SOLID 5 4.000 262.0000 0.00 1048.1( <br /> SERVICE TERM 12 WEEK <br /> 9 CONTS: 4 IMF., S] MAPRFESTB: 006687336SKS FORM CD: US SHIPS 226982481 <br /> CNT#: 181112881594 OTY: 150 WT/VOL P PROFS 1745975 SHOOT 8492411 <br /> CNTB: 161312881595 M. 150 WT/VOL P PROF#1745975 SKIT 8402413 <br /> CNTB: 18DOWS97376 QTY: 150 WT/VOL P PROF#1745975 SKDOT'849443,3 <br /> CNT8: 180907597378 QTY« 150 WrAML P PROF# 1745375 SKDOT 9492411 <br /> 870503 LBH SGL MIXED BATT FOR RE 2.000 150.am 0.00 31b.06 <br /> #CONTS: 2 TON 57 MANIFESTO: 82517 FORM CD: BL SNIP#226982517 <br /> CNT#i.181112481692 QTY: 20 WTAIL P PROF#158608 SKWT 829155 <br /> CNTB: 181112881891 QTY: 20 WT/VOL p PROF#156808 aw 829159 <br /> 1727592/ <br /> 871063 CCS SGL CHAR SOL/SEMI STA 3.000 105.0000 0.00 585.0c <br /> 8 CONTE: 3 TOP: S] MANWIST#: 0 887""SKSPPgqRBMM CDa US SHIP#220982481 <br /> CM: 181112681593 IRIS 35 WT/VDL P PQOF#1727592 SMOO'T 846636 <br /> CNT#: 1811128111592 QTY: 3S WT*L P PROF#027592 5K40'T 846146 <br /> Cm 181112881591 QTY: 35 WT/VOL P PROF# 1727S9z SKDDT 840696 <br /> 706 PAIL. 5.5 GL BLACK POLY W 2.000 11.0m 2.02 28.02 <br /> SERVICE TERM 24 WEEK <br /> 8003368 DMJM, 55 GL BLACK STEEL 0 1.000 85.0000 6.56 91.56 <br /> 100001 FEE, FUEL SURCHARGE 1.0QO 14.1400 1.10 13.24 <br /> ­---------------- <br /> -------------- ------- <br /> TOTAL UCTS, 719.1400 9.71 2oe7.85 <br /> TOTAL CHANGE 2067.85 <br /> CREDTIS 0.00 <br /> -------------- <br /> TOTAL WE 2Od7.85 <br /> UNPAID BALANCE THIS RELIT 2067.95 <br /> GENERATOR STATUS <br /> 220-Uod lbs/month <br /> .0 Customer certifies that (i) the above-sassed 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 /> Generatsi Status is correct. Custemar agreas to pay the a46va charges <br /> and to he bound by the terns and conditions (i) not forth in (a) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> &A*.SK agreement s.ighlid by Costjpotp.Rqd SK, and (2) incorporated <br /> herein by reference. Valois otherwise indicated in the payment <br /> d° 1�.-3`'Sf�c�Mr`�a�-•#u�'-i �teaer•e,crena:,-fnr._..._ .. ..._.. <br /> I <br /> f r 9lgnaha•e <br /> ' CUSTOMER/GENERATOR: tam backer <br /> LAST PAGE <br />