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CSG SK-SSL-BOX-23 Raymond Goinez 10/30/18 14:06 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR FMFRGFNCY: 800-468-1760 (Safety-Xleen) <br /> 2095451011 <br /> REFERENCE NER. <br /> CUSTDKER4 CA47954 Cal-Trans Shop 10- 30110 C" 78307572-1805473341 <br /> 1603 S R St SRVC WEEK: 2016-44 <br /> Stockton CA 95206-2476 SRVC DATE: 10/30/18 <br /> PHONE 209-948-7813 <br /> HILL TO CUSTDMEH# BILL TO ADDRESS: <br /> CA47769 Caltrans Cws - <br /> P0 Bax 1632 <br /> Stockton CA 952D1-3038 <br /> PHONE 209-948-7815 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 1274272/ <br /> 875121 LCCRQ 30GL LP AEROSOLS FO 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 8 WEEK <br /> CAUSE CODF VaidHeaderAndLine -SERVICE NOT NEEDED <br /> 1441605/ <br /> 871063 CCS 5GL CHAR SOL/SEMI STA 7.000 100.0000 0.00 700.00 <br /> # CONTS: 7 TSDF: S1 MANIFEST#: 006687444SKS FORM CD: US SHIP# 225831442 <br /> CNT#: 181026546221 QTY: 10 WT/VOL P PROF# 1441605 SKDOT 7963721 <br /> CNT#: 18I026546222 QTY: 10 WT/VOL P PROF# 1441605 SKDOT 7963721 <br /> CNT#: 18I026546223 QTY: 10 WT/VOL P PROF# 1441605 SKDOT 7963721 <br /> CNT#: 181025546224 QTY: 10 'AT/VOL P PROF# 1441605 SKOOT 7963721 <br /> CNT#: 181028546225 QTY: 10 WT/VOL P PROF# 1441605 SKOOT 7963721 <br /> CNT#: 181026546226 QTY: 10 WT/VOL P PROF# 1441605 SKDOT 7963721 <br /> CNT#: 181026546227 qTY: 10 WT/VOL P PROF# 1441605 SKDOT 7963721 <br /> 40606931/ <br /> 875453 CBP-SLD OR SEMI-SLO TO HA 4.000 75.000D 0.00 300.00 <br /> # CONTS: 4 TSDF: SI MANIFEST#: 006687444SKS FORM CD: US SHIP# 225831442 <br /> CNT#: 181026546232 QTY: SO WT/VOL P PROF# 40506931 SKOOT 7182275 <br /> CNT#: 181025S46233 QTY: 10 WT/VOL P PROF# 40606931 SKDOT 7182275 <br /> CNT#: 18I026546234 QTY: 10 WT/VOL P PROF# 406D6931 SKDOT 7182275 <br /> CNT#: 181026546235 QTY: 10 WT/VOL P PROF# 406D6931 SKDOT 7182275 <br /> 1735164/ <br /> 870601 LFH1-LP FOR FUELS BLENDIN 2.000 200.000D 0.00 400.00 <br /> # CONTS: 2 TSDF: KP MANIFEST#: 006687445SKS FORM CO: US SHIP# 226831447 <br /> CNT#: 181026546249 QTY: 50 AT/VOL P PROF# 1735154 SKDOT 8477721 <br /> CNT#: 181026546250 QTY: 50 WT/VOL P PROF# 1735154 SKDOT 8477721 <br /> 106 PAIL, 5.5 GL BLACK POLY W 5.000 13.0000 5.04 70.04 <br /> SERVILE TERM 24 WEFK <br /> 3345 DRUM, 10 GL RLACK STEEL 0 1.000 76.0000 S.89 81.89 <br /> _ 100065 E-Manifest Fee 2.000 10.0000 0.00 20.00 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS 474.0000 10.93 1571.93 <br /> TOTAL CHANGE 1571.93 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 1571.93 <br /> UNPAID BALANCE THIS RECEIPT 1571.93 <br />