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CSG SK-SSL-1JMO.01 Iaseph R Lima Ir 04/23/18 08:09 PACE.1 <br /> Safety-Kleen Systems, Inc. <br /> 2600 N Central Expy. Suite 200 <br /> Richardson, TX 7SO80 <br /> CORPORATE: 800-669-S740 <br /> 24 HR EMERGENCY: 800-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> CUSTOMER# CA47958 Cal-Trans Shop 30- Lodi Cws 7REFERENCE NBR, <br /> S6597050-1801788910 <br /> 845 E Pine St SRVC WEEK: 2018-18 <br /> Lodi CA.95240-3108 SRVC DATE: 04/23/18 <br /> PHONE 209-533-6953 <br /> BILL 69 CUSTOMER# BILL 10 ADDRESS: <br /> CA97769 Caltrans Cws <br /> Po Box 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 /> 66636 USED OIL RECYCLE AUTOMOTI 160.000 <br /> SERVICE TERM In WEEK <br /> HALOGEN /CLOR-D-TECT TEST RESULT PASS: PPFI 4 1000 <br /> 10256 FEE, OIL SERVICE/6TOP NON 1.000 <br /> SERVICE TERM 16 WEEK <br /> 66665 ANTIFREEZE 010N-PREQUAL) 35.000 <br /> SERVICE TERM 24 WEEK <br /> - <br /> HALOGEN /CLOR-O-TECT TEST UbT--.P4kSS: PPM t 1000 <br /> # CONTS: 1 MOP: EVG MANIFEST#• 0005201215K FORM CO: US SHIP# 225309604 <br /> CNT#; 180923983674 CITY: 35 PROF# 156030 SKpOT 651 <br /> ----------------------------------------- - <br /> TOTAL SERVICE/PRODUC7S <br /> TOTAL CHARGE <br /> CREDITS - <br /> 1DTAL DUE <br /> UNPAID BALANCE 7015 RECEIPT <br /> If high risk source, P.P. certifies that load specific PCB & Silicon <br /> testing have been completed prior to pumping this load. <br /> GENERATOR STATUS <br /> SQG/LQG: Vehicle <br /> Customer certifies that (i) the above-named materials are properly <br /> classified, packaged, marked and labeled, and ere 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) at forth in (a) the <br /> General Terms and Conditions provided separately to Customer ar (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 /> amount equal to the lesser of (i) 1.596 per month 28% per annago 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 /> tFie a.,.vi�. mA nnwLdno„wnt .e Anl v.a,tbnniaed to sign and bind <br />