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CSG SK-SSL-UMO-01 [)avid McCarroll 11/27/18 13:55 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Expy. Suite 700 <br /> Richardson, TX 75080 �� <br /> CORPORATE: 800-1750 40 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NOR. <br /> CUSTOMER# CA47954 Cal-Trans Shop 10- 30110 Cws — 78597759 <br /> 1603 S R St SRVC WEEK: 2018-48 <br /> Stockton CA 95206-2476 SRVC PATE: 11/27/18 <br /> PHONE 209-948-7813 <br /> SILL TO CUSTOMER# RILL To ADDRESS: <br /> CA47769 Caltrans Cws <br /> Po Sox 1632 <br /> Stockton CA 95201-3038 <br /> PHONE 209-948-7815 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 66665 ANTIFREEZE (NON-PKEQUAL) 150.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM < 1000 <br /> # CONIS: 1 6SDF: EVG MANIFEST#: 006687167SKS FORM CD: US SHIP# 221096665 <br /> CNT#: 181127143775 QTY: 150 WT/VOL G PROF# 156030 SKDOT-651 <br /> -------------- ---- -`----- -------- <br /> TOTAL S£RVICE/PRODUCT5 0.0000 0.00 0.00 <br /> TOTAL CHARGE 0.00 <br /> CREDITS 0.00 <br /> ------------ <br /> TOTAL DUE --~ 0.00 <br /> UNPAID BALANCE THIS RECEIPT 0.00 <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-vaned materials are properly _ <br /> classified, packaged, marked and labeled, arid are in proper condition <br /> For transportation ac[or'din9 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 hound 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 /> 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 (1816 per annun) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> anounts outstanding. Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and hind <br /> Customer. Customer acknowledues that it is responsible for maintaining <br /> its Generator Status and obtainingan FPA 20 number if required by <br /> applicable law. The following provision is applicable to <br /> Safety-Kleen's parts cleaner and paint gun cleaner services: Customer <br /> agrees that it will not introduce any substance into the solvent or <br /> aqueous cleaning solution, including v:ithout limitation any hazardous <br /> waste or hazardous waste constituent, except to the ektent such <br /> introduction is incidenlal to the normal use of the machine. Customer <br /> further agrees that it will not clean parts/paint guns that have been <br /> contaminated with or otherwise introduce polychlorinated biphenyls <br /> (PCD's), herbicides, pesticides, dioxins or listed hazardous waste <br /> -1.1--. __ ....._., 11—ai— ­lutinn. Safety-Kleen has the <br />