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<br />FEDVIDN0.39-6080019 IV/iL,I�IIVC 1"LHI..CIViLIN I t-Ut-f
<br />P 5 5 7 41
<br />y (IF DIFFERENT FROM LOCATION)
<br />BOX 1800 - ELGIN, IL 60121
<br />3 16 -
<br />YCCOUNT NUMBER CUSTOMER NAME
<br />?-185-01-8064- HARLEY MURRAY INC
<br />GUST. ORDER NO
<br />iTQCK Naa�j (iV1C�E DE$GFkIPTtQk
<br />UNfr COSTOTA4r10 CLEANER,CHOKE/C
<br />6 2.88
<br />111 PENETRANT 4-00
<br />* 18. 32 SERVICE DATE
<br />11,1 PENETRANT 24 2.88
<br />I
<br />10-17-89
<br />BRUSH ASSY,FLO/ 1 11-40
<br />* 73.27113
<br />* INVOICE NUMBER
<br />12`08
<br />134 LOTION,W/GRIT 8 4 14.75
<br />P55741
<br />574
<br />*
<br />62-54 saLEs rax INeLDoen
<br />TAX COPE
<br />PAY THIS AMOUNT � ❑
<br />NT BY
<br />11-04-89
<br />NUMBER
<br />=OANIFEST
<br />62
<br />knowledge placement of the machine(s) described herein and
<br />the directions for use on the reverse side. I further acknowledge
<br />DATE PLACED MACHINE SERIAL NO.
<br />BRANCH YI c v, ,e�u,,,u ,. do accept the terms and conditions of this machi placement
<br />OUTLET and sql' t reclamation agreement, mooree Sp'ec�i�h Yy+d1 TLrilled an the
<br />7 orf {'/�� //�)'
<br />+/�/ rr/ v arse a�, Lam, f�Y' f - f , '} 1✓
<br />/`
<br />`� '^"
<br />/.'a�/
<br />J l/' ( - CUSTOMER'S SIGNATURE
<br />Safety-Kleen agrees to furnish the above service on its equipment, and customer agrees that all servicing repai d maintenance at the equipment shall be performed by
<br />Safet -Kleen onl All equipment and solvent shall remain the property of Safety-Kieen, and shall be returned to Safety-Kleen upon termination of service. Customer agrees to pay
<br />or rep acemen of equipment due to loss or damage.
<br />Customer agrees to indemnify Safety-Kleen against any loss or claim arising from any personal injury or property damage, however caused, resulting from the placement or use
<br />o[ the machine on the customers premises. Safety-Kleen is not responsible for any violation, loss or ,claim arising from noncompliance with pollution control laws caused by
<br />release of solvent to the environment from the unit and resulting from improper customer handling including, but not limited to spills into adjacent waterways, sewer lines or
<br />gruund water, however caused. However, Salety-Kleen accepts responsibility for any spill caused by its agents In connection wllh the installation or servicing of the machine by
<br />alety-Kleen
<br />CONFIRMATION
<br />DATE OFONEIRMATION ' SALE5 REP. No. SALES SPECIALIST DATE OF FIRST BLITZ PNJ TAX % c.O.M.S. TAX 96 PROD TAX 96 CHAIN SVC PIS PROD PIS
<br />SCHEDULED SERVICE CALL CODE 0,6
<br />(Aj 0 104
<br />ERVICE CUSTOMER'S P.O NUMBER SALES TAX EXEMPTION NO. PLACEMENT CODE GENEnATORICUSTOMER TELEPHONE NUMBER SPECIAL CREDIT CODE
<br />1NrERVAL (WEEKS) ARBA OObE HANDLING
<br />©BLANKET CITEMPORARY �ry f /�
<br />REMIACE DEFECTIVE
<br />�,
<br />hR9ACNIN DEEECTfVE [/� J
<br />3 MACMME COMPETITIVE
<br />SERVICE CHARGE TAX TOTAL REFUSED SERVICE - EXPLAIN
<br />-
<br />[] 4 REPLACE HOME MADE VAT.
<br />© 5 ADDITIONAL MACHINE
<br />UNIFORM -D•US WASTE MANIFEST INFORMATION
<br />----- CONTAINERS ----- "This Ia to certily Illet the above-named malenals are properly classuhed, described, packaged. marked and labeled, and
<br />are in proper condition for Transportation according to the applicable regulations of Ina Department of Transponalion,
<br />i certily that my hazardous waste streams loial
<br />SBPw less than 226 pounds {100 k9) for this calendar
<br />Pails 16 Gal 30 Gel month and that I am not required to obtain an
<br />No. DM TANKS No. DM No. DM EPA Identification number.
<br />DF US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number)
<br />Waste Petroleum Naphtha, Combustible Liquid, UN 1255 (EPA, IGNITABILITY, D001)
<br />Waste Compound Cleaning Liquid Corrosive Material, NA 1760 (EPA, F002) GENERATOR'S
<br />INITIALS
<br />Total Quantity = Number of Drums x Ave. Wt/Drum of: PailsTSSPVV ANKS 16 Gal 30 rel SPENT SOLVENT MEETS YES NO
<br />ACCEPTANCE CRITERIA
<br />DESIGNATED FACILITY NAME AND ADDRESS: SATIETY-KLEEN CORP. USA EPA ID NO.
<br />STATE ID NO.
<br />PRODUCT SECTION
<br />PRODUCT NUMBER DESCRIPTION DEALER UNIT OF QUANTITY SALES AMOUNT TAX LINE
<br />PRICE MEASURE DELIVERED TOTAL
<br />J/. /
<br />C/
<br />/t lJl t iani
<br />r
<br />e2YAe y rhoer7:
<br />3 - .
<br />PAYMENT—
<br />---
<br />—
<br />%[rg
<br />TOTAL P DUCT,gf Dpi AMOUNT
<br />$ ,+
<br />(�+
<br />CASH 1:1 TOTAL RECEIVED APPLY PAYMENT TO,
<br />7/r. ,
<br />[c
<br />_
<br />y,
<br />L INE SERV CE AMOUNT
<br />ItiT
<br />CHECK NUMBER ❑TODAYS SERVICElSALE
<br />❑ PREVIOUS BALANCE AS FOLLOWS
<br />r=�
<br />CLUDIN0 TX)
<br />C4ARPE MY 'AMOUNT FOR TH15 TRANS -
<br />fNW. N �T T, A t%NT $
<br />Ai UNLESS -gTHURwtseDICATEO TOTAL, DUE
<br />'
<br />'
<br />WW. i4 ..,. _.. -�'A O NT $ ....._ -. _ ... --
<br />Also, a ��= marr.0w.. t�.
<br />OF INE ANOENT SOLV SOLVENT ,�SEGTI al
<br />INFORMATION OW Ft(� /� Cr
<br />THE REVERSE SIDI
<br />INV. q AMOUNT $
<br />X <'
<br />GENE R R/CUSTOMER SIGNATURE
<br />INVOICES ARE SUBJECT TO AN INTEREST CHARGE OF THE LESSER OF IW% PER MONTH (1896 PER ANNUM)
<br />OR THE MAXIMUM RATE ALLOVIFEC BY LAW ON ANY UNPAID INVOICES THAT ARE NOT PAID WITHIN 30 DAYS.
<br />PLEASE SEE Rt V��SE SIDE FOR.IMPQRTANT INFIC?RMATIQN IN THE EVENT OF DEFAULT, SAFETY-KLEEN SHALL BE ENTITLED TO RECOVER
<br />COSTS OF COLLECTION INCLUMNG REASONABLE ATTORNEY'S FEES.
<br />
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