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CSG SK-SSL-BOX-23 s. -o ad Gome2 08/23/18 14:01 PAGE 1 <br /> Safety-M een Systems, Inc. <br /> 2G00 N Central Expy, Suite 200 <br /> Richardson, TX 75080 - <br /> CORPORATE: 800-669-5740 <br /> 24 HR ENCUGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NOR. <br /> CUSTOMER# CA37093 Cal-Trans Shop 10- Lodi 77689681-1804165154 <br /> 845 E Pine St SRVC WEEK: 2018-34 <br /> Lodi CA 95240-3108 SRVC DATE: 08/23/18 <br /> PHONE 209.333.6953 <br /> HILL 70 CUSTOMER# HILL lO ADDRESS, <br /> CA39570 CAL Tans - Dist 10 <br /> Po 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 PRICF TAX CHARGE <br /> 26730 MODEL 28 W/STAND 6365 1.000 50.0000 3.88 53,88 <br /> S/N 11013427 TAG 00001112SK11013427 CLEAN 0.250 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> # CON75: 1 TSDF: SCA ,MANIFEST#: 011844883fle FORM CO: US SHIP# 226249416 <br /> CNT#: 180815180708 QTY: 5 WI'/V0L G PROF# 156013 SKDOT 14626 <br /> 04837 MODEL 94 W/2387 8 6365 1.000 88.0000 6.82 94.82 <br /> S/N 94120160 TAG TOOGOODOXX90210003 CLEAN 2.000 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> # CONTS: 1 TSDF: SCA MANIFEST#: 011844883f1e FORM CD: US SHIP# 226249416 <br /> CNT#: 180615180709 QTY: 20 WT/VOL G PROF# 156023 SK00T 14941 <br /> ------------_---------------________ <br /> TOTAL SERVICE/PRODUCTS 138.0000 10,70 148.70 <br /> 70TAL CHARGE 148.70 <br /> CREDITS 0.00 <br /> TOTAL DUE 148,70 <br /> UNPAID BALANCE THIS RECEIPT 148.70 <br /> Machine clean and good condition? Yes <br /> Lp—,issembly Condition Yes <br /> U in place and legible? Yes <br /> Ph. " ,e 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 meats acceptance criteria? Yes <br /> GENERATOR STATUS <br /> 220-2200 lbs/month <br /> Customer certifies that (i) the above nom erials are properly <br /> classified, packaged, marked and labeled, and are in proper condition <br /> for transportation according to the applicable regulations of the <br /> Department of Transportation (ii) no material change has occurred <br /> either in the characteristics of the waste/material or in the process <br /> generating the wastegnaterial, and (iii) the above rcterenced <br /> Generator Status is correct. Customer 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) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authori2ed to charge Customer's account for <br /> this transaction. If Customer fails to make payment When due, of <br /> anount equal to the lesser of (i) 1.5% per month (18% per annme) or <br /> (ii) the maximum Pw,rnnt Allowed by law, will he added to all unpaid <br />