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CSG SM-SSL-BOX-23 <br /> Raymond Game, 01/19/18 08:37 PAGE 1 <br /> Safety-Kleen Systems, Inc, <br /> 2600 N Central Exp,, Suite 200 <br /> Richard"', TX 75080 <br /> 24 HR EMERGENCyO"POR800_A800-669-5140 <br /> 968-1760 (Safety-NleeO) <br /> 2095451011 <br /> CUSTOMER# CA37093 Cal-Trans Shop 10- Lodi REFERENCE NOR. <br /> 845 B Pine St 75686951-1706528268 <br /> Lodi CA 95240-3108 SRVC WEEN: 2018-3 <br /> BILL TO CUSTOMER# PHONE 208-333-6953 SWC DATE: 01/19/18 <br /> CA30570 BILL TO ADDRESS; <br /> CAL Trans - Dist 10 <br /> Po Box 3632 <br /> Stockton CA 95201.3038 <br /> PURCHASE ORDER# PHONE 209-948.7815 <br /> SERVICE/ <br /> PRODUCT/SERVICES TAX EXEMPT# <br /> peobucr • <br /> 26730 MODEL 26 W/STAND 6365 QTY UNIT PRICE - TAX CHARGE <br /> TOTAL <br /> SER 33013927 TAW 000011EEK 12SKII01342]OfLEArySp.250 SPENT 0.080.0 3.88 53.88 <br /> 94837 610DEL�94 W/23872&W6365 SCANNED YES <br /> S99120160 TAG ry0000DOXX90210003OCLEAN82.00UO6.82 <br /> SPENT 0.000 9q.e2 <br /> SERER <br /> # <br /> CON IS: 1 VICE TERM 12 WEEN SCANµ <br /> ISDF: SCA MANIFEST#; O6S316505µS FORM CO: US SHIP# 224312637 <br /> CNT#I 171223661759 QTy; 20 <br /> B PROF# 156023 SRDOI"14941 <br /> TOTAL SERVICEIPRODUCIS <br /> .— 138.0000 10.70 148.70 <br /> TOTAL CHARGE 0,70 <br /> 14 <br /> CREDITS 0.00 <br /> TOTAL DUE <br /> -------148.70-- <br /> UNPAID BALANCE THIS RECEIPT =e__e_e-�- <br /> 398.70 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition yes <br /> Decals in place and legible? YesFusible . <br /> link <br /> Emergency 'losing gOf lid unobstructed? yes <br /> Flash iRe properly grounded? yes <br /> Local Phone No. Sticker Affixed to Machine yes <br /> Spent solvent meets acceptance criteria? yes <br /> GENERATOR STATUS <br /> 220-2200 lbs/month <br /> CPs[amer certifies that (i) eke above-nmual neater{els-ern properly <br /> 0ford ass ifi¢d, PackayeJ, marked and labeled, and are {u <br /> far t/l"IcIllartatinn accorJ my to the applicable regulations of the <br /> trmsnt of tiOn`41- -ortet{o11 Proper tvvllitioil <br /> (ii) no mat '.ial 16000. has ecew•red <br /> either in the characterh,ttrs of tilt Wastepnatm•ial yr in the process <br /> generat5ag the Waste/mato'ial, and (iii) the above referenced <br /> Generator Status is correct: Customer ayrnes to Hay the above cbargea <br /> and to he bound by tilt terms and 1..11µ00s <br /> General Te nnsPanJ Conditions provided s¢paratel fro forth in (a) the <br /> a...i to e....e_. <br /> Customer or (b) <br />