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CSG SR-SSL-80X-23 Reymond Gomez 10/25/17 13:37 PAGE 1 <br /> Safety-Kleen Systems , Inc . <br /> 2600 N Central Espy, Suite 200 - <br /> Richordson, 18 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 C$afety-K1een) <br /> 2095451011 <br /> REFERENCE NBR. <br /> _ 74946970-1704988792 <br /> CUSTOMER# CA47958 845 ErPinO StP 10- Lodi Cws SRVC WEEK: 2017-43 <br /> Lodi CA 95240-3108 SRVC DATE: 10/25/17 <br /> PHONE 209-333-6953 <br /> BILL TO CU570MEP40 BILL TO ADDRESS: <br /> CA47769 Caltrans CWS <br /> Po Box 1632 <br /> Stockton CA 201-3038 <br /> PHONE209-948-781S <br /> TAX E%EMPT# <br /> PURCHASE ORDERk <br /> PRODUCT/SERVICES TOTAL <br /> SERVICE/ QTY UNIT PRICE TAX CHANGE <br /> PRODUCT <br /> 40713004/ <br /> 875460 CNO-NUN HAZARDOUS SOLID 5 1.000 140.0000 0.00 140.00 <br /> SERVICE TERM 12 WEEN FOR, Col US <br /> # CONTS: 1 TSOF 0629235 NIFEST #: 0001039LWTAUL PSkSPROF# 40713004HIP#SKDO147370310 <br /> 3363 DRUM,55 GAL FOR O.F. 2.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> 83383 ORUM,55 WASTE O.F. 1.000 45.0000 0.00 45.00 <br /> SERVICE TERM 12 WEEN <br /> # CUN TSCNT#: 173020329129M QTY: 150i UWT/VOLI PSKSPROF# 156033 SHIP#SkOOT47872976 <br /> 8003369 DRUM, SS GL BLACK STEEL 0 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> CAUSE CODE VoidHeaderAndLine -SERVICE NOT NEEDED <br /> 100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 2.000 O.000U 0.00 0.00 <br /> TOTAL SERVICE/PRODUC 6 195.0000 0.00 185.00 <br /> 'TOTAL CHARGE 185.00 <br /> 0.00 <br /> CREDITS <br /> ------ <br /> TOTAL DUE <br /> 185.00 <br /> UNPAID BALANCE THIS RECEIPT 185.00 <br /> GENERATOR STATUS <br /> 220-2200 lbs/month <br /> Customer certifies that (i) the above-n ane <br /> labele "darerias yroPerrclaud,i[ion <br /> classified, VackageA, marked and A, <br /> for tr anapm•tation accm'dinl to the a0P71ca01e requlatims of.the <br /> D ejwuwlt of Transportetiml U'i) no material change has occurred <br /> ei4her in the characteristics or the was te/material or in the Process <br /> generating the waste/material, and (iii) the above referenceA <br /> Genel•ator Status is correct, wu 1lmne'i ag races to <br /> Pet fla,•thbone to) rhes <br /> n.l ro Ge Imnna Lv rna +oum nn, z e <br />