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CSG SK-SSL-BOX-23 Raymond Game. 04/12/18 14:20 PAGE I <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 NR EMERGENCY: 800-468-1760 (Safety-Klee") <br /> 2085451011 <br /> REFERENCE NOR. <br /> CUSTOMER# CA47958 Cal-Trans Shap 10- Lodi Cu. 76406608-1801394765 <br /> 845 E Pine St SRVC WEEK: 2018-15 <br /> Lodi CA 95290-3108 SWC DATE: 04/12/18 <br /> PHONE 209-333-6953 <br /> BILL TO CUSTOMER# BILL TO ADDRESS: <br /> CA47769 Caltrans Cws <br /> Po Bax 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 PRICE TAX CHARGE <br /> 40713004/ <br /> 875460 CND-NON HAZARDOUS SOLID S 1.000 140.0000 0.00 140.00 <br /> SERVICE TERM 12 WEEK <br /> # CONK: 1 lSDF: GM MPNIFEST#F006513 735X FORM CD: US SNIP# 225142366 <br /> CNT#: 180403SO0766 QTY: 150 OL P PROF# 40713004 SKDOT 7370310 <br /> 3383 DRU14,55 GAL FOR O.F. 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> 63383 DRUM,SS WASTE O.F. 1.000 45.0000 0.00 45.00 <br /> SERVICE TERM 12 WEEK .... <br /> # CONTS: I TSDF: TPO MANIFEST# 0063A592SK FORM CUi US SHIP#225008824 <br /> CNT#: 180317274655 QTY: 200 OL PROF# 1S6033 SKDOT 7872076 <br /> ` 8003369 DRUM, 55 GL BLACK STEEL 0 1.000 0.0000 0.00 0.00 <br /> SERVICE TERM 12 WEEK <br /> 100001 FEE, FUEL SURCHARGE 1.000 0.0000 0.00 0.00 <br /> 3230 TAX HANDLING N/C DRUM DROP 30 1.000 0.0000 0.00 0.00 <br /> -----------------------------------.._---- <br /> TOTAL SERVICE/PRaDUCTS 185.0000 0.00 185.00 <br /> TOTAL CHARGE 185.00 <br /> CREDITS 0.00 <br /> TOTAL DUE 185.00 <br /> UNPAID BALANCE THIS RECEIPT 185.00 <br /> GENERATOR STATUS <br /> 220-2200 lbs/month <br /> Customer certifies that (5) the ahave-nomad 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 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 Term and Conditions provided separately to Customer or (b) <br /> any SK agreement signed by Customer and SX, 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 Custoiner fails to make payment when due, an <br /> amount equal to the lesser of (i) t.595 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 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 an EPA 20 number if required by <br /> applicable law. The fallowing provision is applicable to <br /> Safe;y-Kleen's parts cleaner and paint gon cleaner services: Customer <br /> agrees that it will not introduce any substance into the solvent or <br /> on..... cleaning solution, including without limitation any hazardous <br /> waste or hazardous waste constituent. extent to the ext." such <br />