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CSG SB-SSL-UMO-01 David i1scafroll 12/13/18 09:23 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Espy, Suite 200 <br /> Richardson, 7X 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Xleen) <br /> 2095451011 - <br /> REFERENCE NBR <br /> _ CUSTONERY CA47958 Cal-Trans Shop 10- Lodi CWs 7872908i <br /> 845 E Pine St ERVC WEER: 2018-50 <br /> Lodi CA 95240-3108 SRVC DATE: 12/13/18 <br /> PHONE 209-333-6953 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA47760 Caltrans Cws <br /> Po Bas 1632 <br /> Stockton CA 05201-3038 <br /> PHONE'209-048-7615 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT 0TY UNIT PRICE TAX CHARGE <br /> 40256 FEE, OIL SERVICE/STOP NON 1.000 <br /> SERVICE TERM 16 WEEK - <br /> 66636 USED OIL RECYCLE AU MMOTI 126.00 <br /> SERVICE TERM 16 WEEK <br /> HALOGEN /CLOR-O-TECT TEST RESULT PASS: PPM < 1000 <br /> -------------•-------•------------------- <br /> TOTAL SERVICE/PRODUCTS <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 & Silicon <br /> testing have Leen completed Prior to Pumping this load. <br /> GENFRATOR STATUS <br /> SRG/LqG: Vehicle <br /> Customer certifies that (i) the ubove-named materials are properly <br /> classified, packaged, marked and labeled, and are in proper candition <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 waste/material, and (iii) the above referenced <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 Yerm:s and Conditions provided separately to Customer or (b) <br /> any SK agreement signed by Custoner still SK, and (2) incorporated <br /> herein by reference. Unless otherwise indicated in the payment <br /> received section, SK is authorized to charge Custooep•s account for <br /> this transaction. If Customer fails to make payinent when due, an <br /> amount equal to the lesser of (i) 1.5% par month (18% per amount) ur <br /> (ii) the inasiman amount allowed by law, will be added to all unpaid <br /> amounts ontstiudin9..Customer certifies that the individual signing <br /> this Service Acknowledgement is duly authorized to sign and bind <br /> Customer. Customer acknowledges that it is responsible for maintaining <br /> its Generator Status and obtaining all EPA ID number if required by <br /> applicable low. The following Provision is applicable to <br /> Safety-illaen's parts cleaner and paint quit cleaner services: Customer <br /> agrees that it will not introduce any substance into the solvent or <br /> aqueous cleaning solution, including without limitation any hazardous <br /> v =t arJ,azardoas.waste constituent except to tile extent such <br />