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5400 Legacy Drive,Cluster 11,B3 800-669-5740 DUNS NO. 05-387-6551 FED.ID NO. 3 96090 01 9 CUSTOMER <br /> Piano,Texas 75024 www.safetykleen.com FOR SERVICE CALL BRANCH MANAGER DOC.EXP. ERICE WE <br /> ESCHEDULED <br /> Ia1. CUSTOMER NO. SERVICE WEEE K TERRITORY <br /> 209-545-101 .RALPH TORRES 075/left! 09- 12 25 00387 <br /> 0 U � � Z 6 4 � �+ (� CODE PREVIOUS BALANCE <br /> 0003--2646---64 T D 42, 1£ <br /> TRACY AUTO GROUP LLC EGMENT CHAIN STOME OUTER <br /> SVC.PIC PROD,PIC <br /> 3460;' NAGLEF RLQ � 3460 NAGLEE RD D? 03000 NO 34.1 3414 <br /> a TRACY CA 95304 • TRACY Ch X353`713 LOCATION TAXEXEMPTIONNO. <br /> 718501 <br /> SERVICE DATE ISALES REP NO. I CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EOPT/PROD ORDERED I SERVICE TAX C.O.M,S.TAX I PRODUCT TAX <br /> 2139-820•-110 05-1.45-8. p 0'775 0775 <br /> DEPT SERVICE/ AL REMARKS! SALES TOTAL WASTE SOLVENT/DRUMS CC SERVICE SEACVCErERM E wy PROMO MSDS <br /> PRODUCT j�jjJJjE;�{ UNIT PRICE gUAN. CHARGE TAX CHARGE MIN. Ea�SPENT "°` TERM coDE NO. FLFAJ ?RC1. OIVEN <br /> cera. SK DOT EEKS INITIAL <br /> 0 c�006V44 .158.. "1 .1a. 0J lay. . 8 = 0. 0) 83 1. ❑ <br /> 9 51 0. 7 1 14-1. 2 3 0. 0 l ❑ <br /> -;jie Pec Cie. ❑ <br /> El <br /> ❑ <br /> 10 W'mEla� <br /> El <br /> El <br /> t 'S 7 a �y �y ❑ <br /> 1 _ .3 1 {� 1 t.-, 1 ,-; 0 CHECK G4 D POOR - S NO B NO <br /> TOTAL SERVICE/PROpUCTS APPROPRIATE MACHINE CONDITION ❑ BECAND IN PLACE ❑ MACHINEPROPERLY <br /> NO. <br /> STICKGROUER <br /> ED �T z <br /> ,• •, 6 CLEANLINESS LOCAL PHONE N0.SICK l�-I Z <br /> BOXES <br /> Efl <br /> RISIBLE LINK ❑ AFFIXED TO MACHINE ❑ LL1 <br /> INSTALLED <br /> USEPP.TRANSPORTER'l ID X+10. b0tPi4"ft�m, ID NO, .C�IENERAT�IA USE~PA t13 N0: dENERATOR s9TA-TE 0- N�i ry # LAMP ASSEMBLY RGENCY C SPENT SOLVENI MEETS 2L <br /> T`�R 0 0 0 0 5 0 9 3 0 C:AL 0 0 0 3 3 2 3 5la eDNOmaN ❑ OF uo uNoesTIROCTED ® ❑ ACCEPTANCE CRITERIA ❑ A <br /> 11.US DOT DESCRIPTION INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND Ip. 12.CON AINERS Is, TOTAL t4.UNIT SKDOTNUMBER f,3, 3 CERTIFY THAT MY o7AL <br /> } O TYREQUANTITY WT OL WASTE STRS ARE WITHIN <br /> H. ' ARDOUS WASTE, LIQUID, N. G, S. 9 NA.3082 PG III Lj G 8 39 ONE OF CA7EGORi�.. E FOLLOWING J? <br /> �s'" 3 <br /> _LW9 TRC-#1'71 )AQUE01TS BRAKE SOLUTION ; 8. WAL ) 0102ze TH Z <br /> _ IN rs- Y <br /> R 220 LBS.TO 2,200 LBSJMONTH Q <br /> -� MAR 2 3 RFC'D INITIALS �n <br /> Y GREATER THAN 2,200 LBSJMOMH _� <br /> til <br /> w� <br /> INRIALS o N <br /> DESIGNATED FACILITY NAME AND ADDRESS SAF'ET'Y--KLEEN SYSTEMS,, INC. ICERTIFY THAT NOMAIERIALCHnNGEHAsoccuRREDUSAEPAIDNO. CA0{1CiC308451.? Z� <br /> rp v+I,7;,L L y,t !, EITHER IN THE CHARACTERISTICS OF THE WASTE Q CD <br /> 6000 88TH STREET SACRAMENTO CA 056`28 MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO, � OA0000484517 �Ujl 2 <br /> _ WASTE MATERIALS. <br /> CASH ® TOTAL RECEIVED APPLY PAYMENT TO: j I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE o <br /> CHECK NUMBER _ CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) >F— <br /> ❑TODAY'S SERVICEISALE �`� PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS 07HERMSE I= <br /> ❑PRENDUS BALANCE AS Fi1LL0YlB INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. w 4: <br /> LDR MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) (n <br /> INVOICE# AMOUNT$ INVOICE# AMOUNT$ EDR REQ L) <br /> RIa.A m mdly dim mw anora-aemed aW�era p*dy mead,Md aq.d.mm--d aM im.r.a,.nd era;n <br /> e 1 I �p.reenaua,sotvar�cwaoaa��aetaenaaa�I�e.Fia�oaen.osmao.�mv�omrran.�Ioti• TOTAL DUE 67 <br /> C <br /> PREVIOUS _ _ _ _-u-. ' MANIFEST CODE SEQ# <br /> CREDIT W._._ ..._.,..._. <br /> e P t ►� DO NOT WRITE IN THE FJi.BEL()W <br /> CARD i <br /> Print Lu>t<drrTm l <br /> CREDBT CARD NO, AMF>C EXP:DATE' rr TT� r, ® 0038731092 <br /> VISA • YMC By, om�'�� •..... �r 1 0003-2646-60 -6 <br /> � Cu�5ltartePsW4thoriz Representative f <br />