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CSG SK-SSL-BOX-23 Raymond Gomez 11/08/16 12;45 PAGE l
<br /> Safety-Kleen Systems , Inc .
<br /> 2600 N Central Expy, Suite 200
<br /> Richardson, TX 75080
<br /> CORPORATE: 800-669-5740
<br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen)
<br /> 2095451011
<br /> CUSTOMER# CA37093 Cal-Trans Shop10- Lodi REFERENCE NBR.
<br /> 845 E Pine St 71997909-1603671220
<br /> SRVC WEEK: 2016-46
<br /> Lodi CA 95240-3108 SRVC DATE; 11/08/16 12:44
<br /> .PHONE 209-333-6953
<br /> BILL TO CUSTUMER# BILL 'r0 ADDRESS:
<br /> CA39570 CAL Trans - Dist 10
<br /> P- Box 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 /> 26730 MODEL 26 W/STAND 6365 1.000 50.0000 4.00 54.00
<br /> S/N 11013427 TAG 00001112SKIID13427 CLEAN 1.00 SPENT 0.000
<br /> SERVICE TERM 12 WEEK SCANNED YES
<br /> 94837 MODEL 94 W/2387 & 6365 1.000 88.0000 7.04 95.04
<br /> SM 94120160 TAG TDOOOOOOXX90210003 CLEAN 2.00 SPENT0.000
<br /> SERVICE TERM 12 WEEK SCANNED YES
<br /> # CONN: 1 TSDF: SCA MANIFEST#: 005728338SKS FORM CD: US SHIP# 220793725
<br /> CNT#: 161108290900 QTY: 20 WT/VOL G PROF# 156023 SKDOT 14941
<br /> ----------------____________________
<br /> TOTAL SERVICE/PRODUCTS 138.0000 11,04 149,04
<br /> TOTAL CHARGE 149.04
<br /> CREDITS 0.00
<br /> ' TOTAL DUE
<br /> -------149.04--
<br /> UNPAID BALANCE THIS RECEIPT 149.04
<br /> Machine clean andg od condition? Yes
<br /> Lamp Assembly Condlilti-n Yes
<br /> Decals in place and legible? Yes
<br /> Fgxible link installed? Yes
<br /> Eme19en1y closing Of lid es
<br /> Machine properly grounded? Yes
<br /> Local Phone No. Sticker Affixed to Machine Yes
<br /> Spent solvent meets acceptance criteria? Yes
<br /> GENERATOR STATUS
<br /> 220-2200 lbs/month
<br /> Customer certifies that (i) the above-nwneJ materials are properly
<br /> classified, packaged, marked and labeled, and are it, proper condition
<br /> for transportation ace m•J ing to the applicable regulations of the
<br /> Department Of Transportation (ii) no material change has occurred
<br /> either it, 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 toy the above charges
<br /> and to be b...J Ly the tenors and condition. (1) set forth in (a) the
<br /> an
<br /> General Terni. d Conditions provided o,am.telt' 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, 5K is authorized to chm•ge Customer's account fm
<br /> this transaction. If Customer fails to make payment when due, am
<br /> amount equal to the lesser of (i) 1.5% per "north (18%Per annuga or
<br /> (ii) the maximum amount allowed by law, will be added to all unpaid
<br /> 'uounts outstanding. Customer certifies that the individual signing
<br /> this Service Acknowledgement is duly authorized to sign and bind
<br /> Customer. Custmncr, acknowledges that it is responsible for maintaining
<br /> its Oeneratr Status and obtaining an EPA IO 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 s07ut tun, including without liniitoLlon any Inazardunz
<br /> waste or hazardous waste c-nstituent, except to the extent such
<br /> introduction is incidental to the menial use of tine machine. Custmuer
<br /> further agrees that it will not clean parts/palet guns that have Leen
<br /> ,,ntanivated with or -the rm ise introduce p olydnlorinated biphenyls
<br /> (PCB's), herbicides, pesticides, Aiox ins or listed haaardons waste
<br /> into the solvent m• ayueuus cleaning solution. Safety-Klee, has the
<br /> capacity and is pe rvuitted to accept, store, and/or red aim the spent
<br /> Parts washer solvent; paint thimers, 'olvents and paiots generated by
<br /> customer; or dry cleaning Filter Cartridges, powder, and still
<br /> residues containing perchlureethylena, Not,oleon nophina, or
<br /> triflurotrichl.,.Otho,e nlry cleansing sal van ts. Customer aureez that it
<br /> is respouibl. Forproperly classifying 'its waste st'LO", as Used 011
<br /> or N-nhaaardOns Waste in accordance with the provision of 40 CFR
<br /> 262.11 and applicable state laws. Customer agrees that it will not
<br /> introduce any non-confo..w ing substance into the SK Property,
<br /> incluJ dug, without limitation, any hazardous waste or hazardous waste
<br /> cons t itnert,(i.e., polychlorinated hiphOnyls ("PCBs") herbicides,
<br /> _ pesticides, dioxins, or listed hazardous wastes) except to the extent
<br /> such introduction is incidental to the normal use of tine SK Property.
<br /> III the event of the intruduction Of such nom Cori form lug hazardous
<br /> waste, Customer agrees that it will be responsible for ell Costs and
<br /> eemadi anion expenses related to or arising frau: the propvL wanagemeut
<br /> and disposal of the non-conforming waste, including the cn,t of
<br /> et' ipment decunt'oination and subsequent disposal, Final invoicing
<br /> oni1 be Lased on the actual services provided, which ,way include
<br /> -dditi.mal charges For off specification waste and surcharges. Final
<br /> Invoice 'Count may be more than tle anount listed on the printed
<br />
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