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Raymond Gomez <br /> 11/15/18 09:02 PAGE 1 <br /> :5G SW SSI-BOX-23 <br /> Safety-Klee n Systems, Inc. <br /> 2fiDDN Central <br /> Richardson,ETXy 75080a 20D <br /> COOPORAI L. 800-669-5740 <br /> 24 Mn EMERGENCY: 800-418.1760 (Safety-Nleen) <br /> 2085451011 REFERENCE NOR. <br /> 76421146.1605691209 <br /> CUSTOMER# CA47958 Cal-Trans Shop SO- Lodi Cws SRVC WEEK: 2018-46 <br /> 845 E Pine St SRVC DATE+ 11/15/10 <br /> Lodi CA PHONE 2098333-6953 <br /> BILL TO CUSTOMERO BILL <br /> TOADDRESS' <br /> CA97769 Caltrans Cws <br /> po Box 1632 <br /> Stockton CA PHOS 209-048-7815 NE7815 <br /> TAX EXEFIP7R <br /> PURCHASE ORDER# <br /> PRO®UST/SERVICES TOTAL <br /> SERVICE/ DIVUNI:(PRICE TAX CHARGE _ <br /> PRODUCT 1.000 O.9OOD 0.00 0.00 <br /> 3383 DRI".55 GAL FOR O.F. <br /> SERVICE TERM 12 WEEK 1.000 45.0000 0.00 45.00 <br /> 83383 08UM,55 WASTE O.F. <br /> SERHICE TERM 12 WEEK <br /> 0 IDNJS: I JSDF! T72796F1 0.7YZS15i OW68OL P698 SAS ROF#FORM 1560 S P6SNUOT 7872676 <br /> 1.000 85.0000 1.59 91.59 <br /> S003389 DjUM, 55 GL SERVICE TERML12KWEEKEL 0 _ <br /> 1722256/ <br /> 875410 CNO-NPN HAZARDOUS SOLID 5 1.000 140.0000 0.00 140.00 <br /> SERVICE TERN 12 WEEKt 05 - <br /> a CONTSi I TSDF: SJ 830-4122138M OTY1S190 OWr/VOL7PS�PROF#FORM 17222565NIP0SKOUT98461592 <br /> .80 <br /> 100065 E-Manifest Fee 2.000 IO .000 9000 200.0 <br /> 3230 TAX HANDLING NIC DRUM DROP 30 1.000 0.000- OAO - 0.00 <br /> TOTAL SERVICE/PR000CTS 280.0000 6.59 288.69 <br /> TOTAL CHARGE 296.39 <br /> CREDI75 <br /> y TOTAL DUE -_-----296.59 <br /> ' cvace�o�-se <br /> UNPAID BALANCE THIS RECEIPT 296.50 <br /> GENERATOR STATUS <br /> 220-2200 lbs/month <br /> Customer certifies that (i) the above-named materials are properly <br /> el Ossified. Reckoned. marked and labeled, and are in prover condition <br /> for transportation according to the applicable "BUT <br /> ations of the <br /> Department Of Transportation (ii) Po material chance has occurred <br /> either in the characteristics Of the waste/mnteria7 or in the Process <br /> generating the waste/material, and (iii) the above referenced <br /> Generator Status is correct. Customer a0rees to pay the above charges <br /> end to he 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 Customer's account for <br /> this transaction. If Customer fails to make payment when due. an <br />