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CSG SK-SSL-UMD-01 2oseph R Lima Jr 08/29/18 09:25 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 NOR. <br /> CUSIUMER# CA97958 Cal-Trans Shap 10- Lodi Cws 77803257-1804388563 <br /> 845 E Pine St SRVC WEEK: 2018-3S <br /> Lodi CA 95240-3108 SRVC DATE: 08/29/18 <br /> PHONE 209-333-6953 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA47769 Caltrans Cws <br /> Po Boz 1632 <br /> Stockton CA 95201-3038 <br /> PHONE 209-948-781S <br /> 'PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT QTY UNIT PRICE TAX CHARGE <br /> 66636 USED OIL RECYCLE AUTOMOII 90.000 <br /> SERVICE TERM 16 WEEK <br /> HALOGEN / CLOR-D-TECT TEST RESULT PASS: PPM 4 1090 <br /> '.;60665 ANTIFREEZE (YON-PREQUAL) 5.000 <br /> SERVICE TERM 24 WEEK <br /> HALOGEN /CLOR-D-TECT TEST RESULT PASS: PPM < 3000 <br /> # CONTS: 1 TSDF: EVG MANIFEST#: 006391591sks FORM CD: US SHIP# 226363894 <br /> CNT#: 180829439961 QTY: S WF/VOL G PROF# 156030 SK00T 6S1 <br /> 10256 FEE, OIL SERVICE/STOP NON 1.000 <br /> SERVICE TERM 16 REEK <br /> ----------------------------- ----------- <br /> TOTAL SERVICE/PRODUCM <br /> TOTAL CHARGE <br /> CREDITS <br /> --------------- <br /> TOTAL DUE <br /> UNPAID BALANCE THIS RECEIPT <br /> If high risk source, rep. certifies that load specific PCB a Silicon <br /> testing have been completed Prior to pumping this load. <br /> GENERATOR STATUS <br /> SQG/LQG: Vehicle <br /> Customer certifies that (i) tiro above-named materials 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 Lite waste/matm•ial or in the process <br /> generating the waste/material, sad (iii) the above referenced <br /> Generator Status is correct. Customer agrees to pay the above chary" <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 authorized to charge Custaoer•s account for <br /> this transaction. If Customer fails to make payment when.due, an <br /> amount equal to the Tosser of (i) 1.5% per month (18% per annum) or <br /> (ii) the maximum amount allowed by law, will be added to all unpaid <br /> amounts outstanding. Customer certifies that the individual signing <br /> '_this cwrvirw Ahnnyl , �,. <br />