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1SD1 Gervais Street-Spite 3GG DUNS NO.05-397-6651 FED,ID NO.75-2178928 CUSTOMER <br /> Columbia,South Carolina 29201 FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SCHEDULED SCHEDUiEo <br /> CUSTOMER NO, �Svi� SERVICE WEEK TERRareRORY <br /> 9- - RR Y NR F 4 17 U9-IL KK r1nrj39971Sr. <br /> — CREDIT PREVIOUS BALANCE <br /> CODE PBAL DYER e0 DAYS <br /> 1,4111� L✓h t/+� SUUSSER <br /> TYPE <br /> CHAIN OUTITY PROD.PIC <br /> No Na �oL <br />• ��+1w�1.. LOCATION TAX EXEMPTION NUMBER <br /> 7 1 PSfil <br /> SERVICE DATE ISALES REP N0. CUSTOMER P.O.NUMBER - <br /> CUSTOMER PHONE# TAX CODE HANDurvG Assoo SERVICE TAX C.O.M.S.TAX PRODUCT TAX <br /> woE CODE <br /> a RR <br /> SFR [Al- HLORINE TEST RESULTS CHANGE ,E 1 7 . <br /> SERVICE/ SALES TOTAL <br /> DEPT UNIT PRICE QUANTITY CHARGE SK DOT SERVICE cxxxxr PROMO <br /> PRODUCTNUMqFg TAX CHARGE "per"��u�F N rgHLOIi-a�ShiMWmus NUMBER CC TERM (WEE�EINI PIA ux.Nlr NO. RELEASE NO. <br /> ❑ ❑ 9 <br /> rinfln 1 n rtn ❑ ❑ T <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ Ic <br /> TOTAL-SERVICE/PRODUCTS ,j�` �"v . x„91 TANK • DATE <br /> J jj!/ CAPACITY <br /> E <br /> GENERATOR ONLY ONE BOX BELOW <br /> MANIFEST NO. USEPA TRANSPORTER ID NO. X <br /> GENERATOR: VEHICLE OTHER 1NO PREQUAL REQUIRED,NO HALOGEN TEST I `f OTil�11 FT 7111II T PRINT NAME SIGNATURE <br /> HAZARDOUS WASTE FLUIDS NON-VEHICLE 2 NO PREQUAL REQUIRED.HALOGEN TESTAT PICK-UP C DATE / / C <br /> CLASSIFICATION• oNly FLUIDS 3PREQUAL REQUIRED,NO HALOGEN TEST GENERATOR USEPA ID'NO, GENERATOR STATE ID NO. ° <br /> CESOG ❑ 1 ❑S A PREOUAL REQUIRED.HALOGEN TEST AT PICK-UP a <br /> SOG/LOG `. ❑4 'REFER TO REVERSE SIDE FOR DEFINIIWdS X n <br /> PRINT NAME SIGNATURE <br /> 11.US DOT DESCRIION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12 GONtAINERS 13. TOTAL 1a.uHrt SK WTNUMaER <br /> JSFn r![l, NnN-RCRA HAFARnUUS HASTE (NIT U.S. OiJT REf.ULATF0) N T m G LL?49 Z <br /> ww <br /> >O <br /> ¢O <br /> w CARE. <br /> WE <br /> yJ <br /> DU O <br /> w2 <br /> �Y <br /> O <br /> NTERMEDIATEFACILITYNAMEANDADDRESS R C STf!CK [Nr ©ISTRISUTING USA EPA ID NO. CAT 11111126n, L)U <br /> 7300 CNFYR N NAY OixOIt In <br /> N CA 9SE,?V STATE ID NO. -_jJ <br /> CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE TOTAL DUE _ Oa <br /> CHECK NUMBER INDICATED IN THE PAYMENT RECEIVED SECTION. in <br /> ❑rooArs sERMCE�sae <br /> ❑PREVIOUS BAUNCE AS FOLLOWS 01e1o' � °ew ve eeoa..mea"wWou°'°PePM aeeSI aexmeeo.NH®ReJ,"°^"'I DO NOT WRITE IN THE AREA BELOW <br /> LLS ltlMef.eN en In P'Wer mWlIV,UVeNpM.lm eenyMgmnro Mgxatle y,WMU MIM <br /> V.S.DITIO N L TERMS AND COIM D.S.CNS ON THE RE It R <br /> INVOICE# AMOUNT$ INVOICE# AMOUNT$ 00039D73St1 <br /> x ADDITIONAL TERNS AND CONDITIONS ON THE REVERSE SIDE OF THIS <br /> REMOUS _ _..___-..._ MANIFEST CODE SEOd DOCUMENT ARE INCORPORATED HEREWITH MADE A PART HEREOF. <br />:ARD NO <br /> REDIi -e DIT A IN PDAry ,Q��� r��3w_351Z-15 -+t <br /> AMEX IE.13r (�JL.�('� <br /> NSA / <br />�USTOMER REFERENCE B �' D SO�TV <br /> rouennAl --- <br />