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CSG SK-SSL-UMO-01 Johnny Owens 16/18/18 07.14 PAGE 1 _ .... f <br /> 6 � <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> Z4 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NBR. <br /> CUSIOMER# CA47954 Cal-Trans Shop 10- 30110 Cws 78030743-1804883858 - <br /> 1603 S B St SRVC WEEK: 2018-42 <br /> Stockton CA 95206-2476 SRVC DATE: 10,48/18 <br /> PHONE 209-948-7813 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: ' <br /> -CA47769 - Caltrans Cws <br /> Po Box 1632 <br /> Stockton CA 95201-3038 _ <br /> PHME 209-948-7815 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE . <br /> 66665 ANTIFREZIE (NON-PREQUAL) 1.000 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE voidHeaderAndLine -SERVICE NOT NEEDED <br /> 10256 FEE, OIL SERVICE/STOP NON 1.000 <br /> SERVICE_TERK 8 WEEK <br /> 66636 USED OIL RECYCLE AUTOMOTI 496.000 <br /> SERVICE TERM 8 WEEK <br /> HALOGEN / CLOR-0-TELT TEST RESULT PASS: PPM a 1000 <br /> # CONTS: 1 TSDF; EVG MANIFEST#: 006776299sks FORM CD: US SHIP#ZZ6569889 <br /> CNT#: 181018383930 QTY: 496 WT/V0L G PROF# 156017 SKDOT 11249 <br /> ----------------------------------------- <br /> TOTAL SERVICE/PRODUCTS <br /> TOTAL CHARGE <br /> CREDITS <br /> --`------------ <br /> TOTAL DUE <br /> UNPAID BALANCE THIS RECEIPT <br /> if high risk source, rep. certifies that load specific PCS &Silicon <br /> testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> SQG/LQG: Vehicle <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 r <br /> "General Terms and Conditions provided separately to Customer or (b) <br /> ,any SK agreement signed by Customer and 5K, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Customer's account for <br /> this transaction. If Customer fails to make payment when due, an <br /> amount equal to the lesser of (i) 1.5% per month (19% per annum or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding, Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br /> Customer. Customer acknowledges that it is responsible for maintaining <br /> itc Generator Status and obtaining an EPA ID number if required by <br /> applicable law. The following provision is applicable to <br />