|
1000 North Ranaall HOaG __
<br /> Elgin,Ylltnols 86t23-7857. i TRANSPORTER
<br /> FSFC CS WEEK vCEtERRTGRY . NUMBERe Illr�r0')-345-1011+ COMPANYUN , ~ :`.: 03 �o5�3i3
<br /> sas-�i Raza-
<br /> .'L D R- rzs=VU o—a�t� ku
<br /> YRAN5PE1ftTATI,7f+i CO
<br /> • .:
<br /> T _ 781'.. SWIFT .
<br /> 0 ' STQCKTE7�1 " CA 9�2C5
<br /> d
<br /> A l f SALES HANDLING CREDIT. PREVIOUS PORTION LLLL
<br /> SERVICE DATE:- SA�:T
<br /> 'S NO. SPECtausr SALES TAX EXEMPTION NUMBER GODS CODE BALANCE OVER Eo DAYS
<br /> XxXx G / lli aatiBUTNpEss CHAIM CU P MBE ENERATDRIDUSTOMER PHONE 1 O.C. SVC PPS PROD,PPS SERVICE TAX C.O.M.S.TAX PRODUCT TAX Tl,
<br /> c? 6
<br /> Pic . " 2G9-943-1 +75 , 14 t3 951 031 .U77� .t37l�
<br /> Wi
<br /> t,2 - PLEAS=CHECK`
<br /> MACHINE`-- SERVICE SALES TOTAL SERVICE CHC TE CHANGE O 1 1 1 APPROPRIATE BOXES
<br /> TERM SEFIVICE TERM sCxEOUt.E 017E REMARKS y
<br /> NUMEER' C'IARGE TAX CHARGE ;;- � a- YY MM iOQO POOR
<br /> t301-40602. 14 5.50 61,18 1 13.5 d 05 ' MACHINE coNESS 0 �
<br /> 2 .. - '. - - LAMP ASSEMBLY _
<br /> CONDITION
<br /> d Y NO
<br /> • DECALS IN PLACE
<br /> AND LEGIBLE
<br /> 7 FUSIBLE
<br /> 7 EMERGENCY CLOSING p LJ CI
<br /> - OFUCUNCBSTRUCTED
<br /> MACH+NE PROPERLY 'TI
<br /> 9 GROUNDED LLJJ
<br /> 1 O - - LOCAL PHONE NO. ❑ ❑
<br /> STICKER AFP><ED
<br /> TO MACHINE
<br /> SPEf,IT SOLVENTCE
<br /> ❑
<br /> 1 wE. ACCEPTAN
<br /> CRITERIA
<br /> 12
<br /> TOTAL GENERATOR USA EPA ID NO. GENERATOR STATE ID NO.
<br /> SERYICES>_CTION k05,'S0 8• la; I13e68 CAL{o00042993 . t�S-.I9a-44237
<br /> e e. e "T}is s to cemh mal Ins LBIOrl�i1'ied materials ve progeny c: 6egro.�eier9ed,packaged.mancetl artd vber0.Rasa are n proper cantle'°"fa. t certify that my total waste stre2m8 ate within One Of
<br /> aeasawtavon aures ro me aadicaaa remAa-oiv of ttie DrauuneM aP Transoaralion. the follew{ng categories:
<br /> CONTAINERS VS DOT DEScaIPTION USEPA TRANSPORTER
<br /> PA S T� 16 OM No
<br /> O(3o :.1 T'.yCR GAL. (INCLUDING PROPER SHIPPING NAME.HAZARD CLASS.AND ID-) Ip2f ILD984908202 --
<br /> 1 010 2201bsJrnonth
<br /> Yleste COmbust+ble Liquid,N,O.S.JP.--II Naphlnal 1 IN G A L L 0!JFw),NDIOR le GAL.DRUMS
<br /> . NAti993 PGM IEPA,0001,0018,CO391 r,ERG 8271
<br /> 1 RO waste Combustible Liquid,N.O.S-(Pelraeom Naphtha) �� G A L L,0 N� 30 GAL.DRUMS 220 lbs.to 2.200 IbSJmonth
<br /> NA 7999 P..IEPA.DOOi,001.8,0039)IERO x271 _
<br /> RO Waite Compounds.CIWing Liquid.(ManoamenoI3M,ase) �' _iAL L S PRODUCT
<br /> 8,NA1780 PGM(EPA.DON,0007,D008.0018,DO-2I,D0V-D0M.D0"fERG,801{ NO.669 1,
<br /> —71 Greater than 2.200 IbsJmonth Tu
<br /> L A U 051-3906
<br /> SAFETY—KL
<br /> DESIGNATE[)FACILITY NAME AND ADDRESS: r_LN UK EPA ID NO,
<br /> , USA
<br /> 5050 SAL i DA 3LVDALIi3A >, CA, 95368 STATE ID NO.
<br /> • � � I F;.4
<br /> r
<br /> SOLD ON PREVIOUS SERVICES - PRODUCT MSDS PRICE UIM D LIVERY SALES - 'TAX - LlNE'TOTAL
<br /> NUMBER - DESCRIPTION GIVEN DELIVERED AMOUNT - I
<br /> 2 PRIOR PRIOR LAST
<br /> 0
<br /> x
<br /> . a.
<br /> A. cl
<br /> Y
<br /> ,
<br /> D7
<br /> ' 2e1a �I r•f i t
<br /> TOTAL PRODUCT AMOUNTS
<br /> - CASH ❑ TOTAL RECEIVED APPLY PAYMENT 7fY.. -
<br /> CHECK NUMBER ❑TODAVS SERVICPI$AL6 CHARGE MY ACCOUNT FOR THIS TRANSACTION TOTAL SERVICE AMOUNT
<br /> ♦] PREVIOIJSSAIANCEASFOLOWS UNLESS OTHERWISE INDICATED IN THE PAYMENT ) /
<br /> RECEIVED SECTION. THE RECLAMATION AGREE-
<br /> MENT,ADDITIONAL TERMS AND CONDITIONS,AND
<br /> I OTHER INFORMATION APPEARING ON THE FIE-
<br /> INV.p AMOUNTS - VERSE S:CE ARE MADE A PART HEREOF. THE TOTAL DUE ,
<br /> ABOVE AMOUNT IS SUBJECT TO,AN INTEREST
<br /> CHARGE OF THE LESSOR OF I,/z o PER MONTH
<br /> INV,# AMOUNT$ t8% PER ANNUMI OR THE MAXIMUM RATE AL- IN THE EVENT OF C=_FAULT,SAFETY•KLEEN SHALL BE ENTI-
<br /> VOWED BY LAW
<br /> IDW NY UNPAID INVOICES THAT ILEO TO RECOVER CCSTS OF COLLECTION, INCLVOING
<br /> INV:X ' AMOUNT$ R N RID I IN DAYS.
<br /> REASONABLE ATTORNEY'S FEES.
<br /> Print1 l
<br /> Name �� �...!
<br /> IN EVENT OF GER,.TOR,DESIGraTEp RrPRESENTATNE SIGNATURE ,
<br /> I t e
<br /> .- .. -- -- ==cc ;,nc enq n•vngrSNIT Imcnnik4ITln
<br />
|