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CSG SK-SSL-UMO-01 Joseph R Lima Jr 08/04/1, 07:18 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 EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NEB. <br /> CUSTOMER <br /> CA47958 Cal-Trans Shop 10- Lodi Cws 74413185-1703907289 <br /> 845 E Pine St SRVC WEEK: 2017-31 <br /> Lodi CA 95240-3108 SHVC DATE: 08/04/17 <br /> PHONE 209-333-6953 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA47769 Caltrans Cws <br /> Po Box 1632 <br /> Stockton CA 95201-3038 <br /> PHONE 209-048-7815 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 10256 FEE, OIL SERVICE/STOP NON 1.000 <br /> SERVICE TERM 16 WEEK <br /> 66636 USED OIL RECYCLE CRANKC'AS 170.000 <br /> SERVICE TERM 16 WEEK <br /> HALOGEN / CLOR-O-TECT TEST RESULT PASS: PPM a 1000 <br /> # CONIS: 1 WF: EvG MANIFEST#: VU6136998SKS FORM CU: US SHIP# 223070221 <br /> CNT#: 170804090856 QTY: 170 WT/VOL G PROF# 156017 SMOOT 11249 - <br /> _____________, ---___.-__..___-______- - <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 cmnPleted prior to pumg,ing this load. <br /> GENERATOR STATUS <br /> SQG/LQG: vehicle <br /> Custower certifies that (i) the sbova-owned nmterials are pruperly <br /> rlassified, packaged, marked and labeled, and are 5n Proper condition <br /> fm, traiupottatiun according to the applicable regulations of the <br /> Department of TransPortat'ion (ii) no material change has occurred - <br /> either in the ch ere.teristics of the waste/material or in the process <br /> generating the waste/material, and (iii) the above referenced <br /> Generatm' Status is correct. Custener agrees to Pay the above charges <br /> and to be bound 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) ill corpm..Led <br /> herein by reference, Unless otherwise indicated it. the payment <br /> received section, SK is authorized to charge Customer's account fur <br /> this tansactiun. If Customer fails to make payment when due, an <br /> amount equal to tole lesser of (i) 1.5% per month (18% per annum) or <br /> (i i) the maximum amount allowed by law, will be added to all .,,paid <br /> amuwrt5 outstanding. Custouer ...tifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br /> Custener. Custommr acknowledges that it is responsible for maintaining <br /> its Generator Status and obtaining an EPA ID number if required by <br /> applicable law. The fallowing provision is applicable to <br /> Safety-Kleen's Parts cleaner and paint gun cleaner services: Customer <br /> aUrees that it will not introduce any substance into the ..,vent or <br /> aqueous cleaning soluti.,,, including without limitation any hazardous <br /> waste or baxardous wwau. r..ns;n.o„.. ..�.�.r .., rL. .r r.... --c <br />