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CSG SH-SSL-BOX-23 Raymond Gomez 07/05/18 11:51 PAGE 1 <br /> '1 Safety-Kleen Systems, Inc . <br /> 2600 N Central Expy, Suite 200 <br /> Richardson. TX 75080 <br /> CORPORATE: 800-669-5740 <br /> 24 HR EMERGENCY: B00-468-1760 (Safety-Kleen) <br /> 2095451011 <br /> REFERENCE NOR. <br /> CUSTOMER# CA37093 Cal-Trans Shop 10- Lodi 771254564802048489 <br /> 94S E Pine St SOUL WEEK: 2018-27 <br /> Lodi CA 95240-3108 SRVC GATE: 07/05/18 <br /> PHONE 209-333-6953 <br /> BILL TO CUSTOMER# BILL N ADDRESS: <br /> CA39570 CAL Trans - Dist 10 <br /> Po on. 1632 <br /> Stockton CA 95201.3038 <br /> PHONE 209-948-7835 <br /> PURCHASE ORDER# TAX EXEMPT# <br /> PRODUCT/SERVICES <br /> SERVICE/ TOTAL <br /> PRODUCT 'QTY UNIT PRICE TAX CHARGE <br /> 26730 MODEL 26 W/STAND 6365 - 1.000 50.0000 3.88 53.88 <br /> SM 11013427 TAG 00001112SK11013427 CLEAN 0.250 SPENT 0.000 <br /> SERVICE TERM 12 WEEK UANNEO, <br /> # CONTS: I TSDF: SCA MANIFEST# 00654208358 ORM CO: U5 SHIP# 225]05141 <br /> CNT#: 180609926381 QTY: 5, WT OL PROF# 156013 SKDOT 14626 - <br /> 94831 MODEL 94 W/2387 8 6365 1.000 88.0000 6.82 94.82 <br /> S/N 94120160 TAG TOOOOOOOXX90230003 CLEAN 2.000 SPENT 0.000 <br /> SERVICE TERM 12 WEEK 5 <br /> # CONTS: 1 TSOF: SCA MANIFE'- a �O -42083SK ORM CD: US SHIP# 225705141 <br /> CNT#: 190609926382 QT+ WF/VOL G PROF# 156023 SHOOT 14941 <br /> --------_____________________ <br /> TOTAL SERVICE/PR00.- 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 349.70 <br /> Machine clean and good condition? Yes <br /> Lamp Assembly Condition Yes <br /> Decals in place and legible? Yes <br /> Fusible link installed? Yes <br /> Emergency closing of lid unohstructed? 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 /> 220-22UO lbs/month <br /> Customer certifies that (i) the above-named materials ai_ propc.ly <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 /> generatingthe waste/material. and (iii) the above referenced <br /> Generator Status is correct. Customer agrees to nay the above Charges <br /> and to be bound by the terms and conditions (1) set forth in (a) the <br /> General Terms and Conditions provided separately to Customer or (b) <br /> any SK agreement signed by Customer and SK, and (2) incorporated <br /> herein by refepence. Unless otherwise indicated in the payment <br /> received section, 5K 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.S96 per month (18% per amp-0 or <br /> (oil thw mXr in,nm amnnnl ull m.,a.l 1... l=.= .frill Gn =AA nrl hn vll ..nn.iA <br />