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t <br /> I <br /> CSG SK-SSL-BOX-23 Raymond Gomez 04/12/16 14:23 PAGE 1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy, Suite 200 <br /> Richardson, TX 75060 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Klee" <br /> 2005451011 <br /> CUSTOMER# CA37093 Cal-Trans Shop 10- LodiREFERENCE Ng", <br /> 845 E Pine St 76406598-1801394755 <br /> Lodi SRVC WEEK: 2018.15 <br /> . SRVC <br /> DATE; 04/12/18 <br /> BILL TO CUSTOMER# BILL TO PHONE ONE5209-333-6953 <br /> CA39570 CAL Tran?- Dist 10 <br /> Po Bax 1632 <br /> Stockton CA OSZO1-3038 <br /> PURCHASE ORDER# PHONE 209-948-7815 TAX EXEMPT# <br /> SERVICE/ PRODUCT/SERVICES <br /> PRODUCT 9TY UNIT PRICETAX CHARGE TAL <br /> 26730 MODEL 26 W/STAND 6365 1.000- 50.0000 3.88 53,88 <br /> S/N 11013427 TAG 00001112SK11013427 CLEAN 0.250 SPENT 0.000 <br /> SERVICE TERM 12 WEEK SCANNED YES <br /> 94837 MODEL 94 W/2387 8 6385 1.000 88.0000 6.82 94.82 <br /> S/N 94120160 TAG T00000DOXX90210003 CLEAN 2.000 SPENT 0.000 <br /> #CONTS: YESSERVICE0 E5 <br /> 2 WEEK <br /> 05KSJFORM CD; US SHIP# 225142392 <br /> CNT#: 180317274637 DIY: 20 WF/VOL G pROF# 156023 SKOOT 14041 <br /> ------------------------------------_--- <br /> TOTAL SERVICE/PRODUCTS 138.0000 10.70 148.70 <br /> TOTAL CHARGE 148.70 <br /> CREDITS 0.00 <br /> --------------- <br /> TOTAL DUE 148,70 <br /> UNPAID BALANCE THIS RECEIPT 148.70 <br /> Machine clean and goad condition? as <br /> Lamp Assembly Condition Yes <br /> Decals inPlace and legible? Yas <br /> Fusible link installed? Yes <br /> Emergency closing of lid unobstructed? Yes <br /> Machine 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 /> Customer certifies that (i) the above-named materials are properly <br /> classified, packaged, marked and labeled, and are in uroper 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 /> r generating the waste/material, and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to Pay the above charges <br /> and to he bound by the terms and conditions (1) set forth in (a) the <br /> General Terms and Conditions provided separately to Custamtr or (U) <br /> Ally 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 Customers accoant for <br /> thio transaction. If Customer fails to makt payment when due, an <br /> (amount equal to the lesser of (i) 1.5% per month (18% per annum) or - <br /> (ii) the maximum amount allowed by Taw, will be added to all unpaid <br /> amounts outstanding. C, 1t .. .....p4.- .._- .,.- __._.._.,_... . . <br />