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CSG SK-SSL-BOX-23 Raymond Gomez 10/25/17 13:39 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Exp,, Suite 200 <br /> Richardson, TX. 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2005451011 <br /> CUSTOMER# CA37093 Cal-Trans Shop10- Lodi REFERENCE NOR. <br /> 845 E Pine St 74946962-1704988784 <br /> SRVC WEEK: 2017-43 <br /> Lodi CA 95240-3108 SRVC DATE: 10/25/17 <br /> PHONE 208-333-fi 853 <br /> BILL TO CUSTOMER# CALL TO ADDRESS; <br /> CA39570 CAL Trans - Dist 10 <br /> Po Box 1632 <br /> Stockton CA 95201-3038 <br /> PHONE 209-948-7815 <br /> PURCHASE bflDERq � TAX EXEMPT# <br /> sERvice/ PRODUCT/SERVICES <br /> TOTAL <br /> PRODUCT <br /> QTY UNIT PRICE TAX CHARGE <br /> 26730 MODEL 26 W/STAND 6365 1.000 50.0000 3.88 53.88 <br /> S/N 11013427 TAG 00001112SK1101342? CLEAN 0.250 SPENT 0,000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> # CONTS; 1 TSOF: SCA MANIFEST#: 006363462SKS FORM CO: US SHIP# 223586808 <br /> CNT#: 170930931576 On: 5 W3/VOL G PROF# 156013 SKOOT 14626 <br /> 94837 MODEL 94 W/2387 8 6365 1.000 88.0000 6.82 94.82 <br /> S/N 94120160 TAG TOOGDOOOXX00210003 CLEAN. 2.000 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> # CON IS: 1 TSDF: SCA MANIFEST#: 00636346ZSKS FORM CO: US SHIP# 223565808 <br /> CNT#: 170930931577 QTY: 20 WT/VOL G PROF# 156023 SKDOT 14941 <br /> -------------------_------________________ <br /> TOTAL SERVICE/PRODUCTS 138.0000 10.70 148.70 <br /> TOTAL CHARGE 148.70 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 148.70 <br /> UNPAID BALANCE THIS RECEIPT 148.70 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <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-caned materials are properly <br /> classified, packaged, marked and labeled, and are in proper carditiou <br /> for transportation according to the applicable regulations of the <br /> Departmrcnt of Transportation (i 5) no mater tial change bas Occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the waste/ovate rdal, and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above charges <br /> and to be Lound by the terms and conditions (1) set forth in (a) tire <br /> General Terms and Conditions Provided separately to Customer or (b) <br /> any SK agreement signed by Customer and SK, and (2) incmlrorated <br /> herein by reference. Unless otherwise indicated in the payment <br />