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CSG SK-SSL-UMO-01 I...ph A Life Jr 04/27/16 13:57 PACE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central ESO,, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 MR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> CUSTOMER# CA47958 Cal-Trans Shop 10- Lodi Cws REFERENCE69868730845 E Pine St SWC WEEK: 2016-13 <br /> Lodi CA 95240-3108 SWC DATE: 04/27/16 13:57 <br /> PHONE 209-333-6953 <br /> RILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA47769 Caltrans Cws <br /> Po Bos 1632 <br /> Stockton CA 95201-3038 <br /> PHONE 209-948-7815 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> SERVICE/ PRODUCT/SERVICES <br /> PRODUCT TOTAL <br /> 66636 USED OIL NON- QTY UNIT PRICE TAX CHARGE <br /> PEE SERV I40.000 <br /> 16 W <br /> SERVICE TERM 16 WEEK - <br /> HALOGEN E. USE /OIL <br /> TEST RESULT PASS: PPM a 3000 <br /> lOZSfi FEE, USED OIL STOP CHARGE 1.000 <br /> TOTAL SERVICE/PRODUCTS <br /> TOTAL CHARGE <br /> CREDITS <br /> TOTAL DUE <br /> UNPAID BALANCE THIS RECEIPT <br /> If high risk source, rel• certifies that load specific PCB & Silicon <br /> testing have been completed prior to puinping this load. <br /> GENERATOR STATUS <br /> SQG/LQG: Vehicle <br /> Costumer certifies that (i) the shove-named nmterials are properly <br /> Classified, packaged, marked and labeled, and are in proper condition <br /> for L•ansportation according to the applicable re0.1ations of the <br /> OePartnrent of Transp.rtatgoo (ii) n. material change hes occurred <br /> either in the characteristics of the wasaterial or in the process <br /> generating the waste/ofaterial, and (ite%m <br /> ii) the above refermiced <br /> Generator Status is correct. Co.fomer agrees to pay the above tharges <br /> responsible for informing Safet _ "r ��eo`a`ious ann Cuftoiner"{s <br /> alter the characteristics of the nater iaon f apro vddedfny sI changes <br /> sV that <br /> OF ay <br /> AN EMERGENCY CALL *<2q-HR NUMBER*+' 1-800-468-1760 (Safety-kleen) <br /> I have es ta4lisheA a pro9 ran to reduce the volume or quantity and <br /> toxicity le the hazardous waste to the degree to be economically <br /> practicabl r. <br /> SI rture _ <br /> CUSTOMER /GENERATOR: Cal-Trans Shop 10- Lodi Cws daviA johns.. <br /> r <br /> signature <br /> TRANSPORTER: Joseph R Lima Jr <br />