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IAM 2600 North Central Expressway, Suite 200 800-669-5740 ..� DUNS NO. 05-397-6551 FED ID NO 396090019 CUSTOMER Richardson, TX 75080 www.safety-kleen.com we vwKG r tpq�. CUSTOMER NO. FOR SERVICE CALL BRANCH MANAGER DOC. EXP SCHEDULED SCHEDULED SE E WEEK TERHITORI _ C U 1J 1" 0CODECRIDIT r DBO 1 190 PREVIOUS BALANCE BAL. VER 60 DAY 5 T Q Oba California Specialty Cheese J Airport Way 14253 S Airport Way USTOME CHAIN OUTER SEGMENT COUNTY SVC P/C PROD RC M LOCATION TAX EXEMPTION NO. E • R • Manteca, CA 95336-8641 US Manteca CA US 95336-41641 ...a SERVICE DATE SALES REP N0. I CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE I DATE EQPT/PROD ORDERED SERVICE TAX C.OAI S. TAX PRODUCT "TAX SERVICEi REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE wm;E SDS DEPT QUAN CHARGE CC SERVICE1Y PHOMO TERM $tRDAIS INV PRODUCT UNIT PRICE TAX CHARGE MIN, CI FAN ^PENT • r� SK DOT TERM KS,urnnnl — CODE NO GIVEN 1 •rF, .'{, ❑ J.7 64. Oir--. ; ❑ �c . I, / V- ❑ 6 L� r,., 1 , 1_1 ❑ 9 ±� ...-r + 6'J r �_�I,� , _.:G.: 1 ,. bto "� l ; T !e: L-. ❑ 12 0 ou El eYL. CHECK GOOD POOR YES NO YES NU TOTAL-SERVICE/PRODUCTSAPPROPRIA1e DECALS IN PLACE ❑ [i MACHINE PROPERLY GROUNDED El r BOXES ME]ACHINL CONDITION AND LEGIBLE LOCAL PHONE N0. STICKER 8 CLEANLINESS FUSIBLE LINK ❑ ❑ AFFIXED TO MACHINE ❑ ❑ USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLY ❑ ❑ EMERGENCY OCIOSINGsPENr sDLVENr MEETS OF LID UNOBSTRUCTED ❑ ❑ ACCEPTANCE CRITERIA ❑ ❑ Z W �e� V 11 US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) 12. CON N AINERS TYP IJ TOTAL ANnTY 14 UNIT WT VOL SK DOT NUMBER I CERTIFY THAT MY TOTAL WASTE STREAMS ARE WITHIN 111 A ,` G ''" ONE OF THE FOLLOWING CATEGORIE O 0 TO 220 LBS lMONTHH/ t :rte Z INITIALS i LU Q 220 LBS TO 2.200 LDS /MONTH 0 l� C INITIALS W N J� fHEA?ER THAN 2.200 LOS; MUNHI Q� D. INITIALS 0 0�. DESIGNATED FACILITY NAME AND ADDRESS I CEHIIFY THAI NO MATERIAL CHANCE HAS OCCURREDUSA EPA ID EITHER IN THE CHARACTERISTICS OF THE WASTE NO. Z a Ip W CO CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. WASTE MATERIALS AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND MANIFEST NO. TOTAL CHARGE // . / 7 -I yV o CHECK NUMBER ❑ TODAY'S SERVICE+SALE BALANCE AS FOLLOWSLDR CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE INDICATED IN THE PAYMENT RECEIVED SECTION, THE INDIVIDUAL SIGNING THIS DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS (FROM ABOVE) O > F Q WASTE MIN. W d ❑PREVIOUS (FROM ABOVE) MESSAGE � INVOICE N AMOUNTS INVOICE # AMOUNTS 'TL. s 1u caroti mel 1. ara a --m .— re P+ate,Y 11-4— Ou .J. nw.w e,a woelea WaP«caauu wl,a.0 um„e �a,noml s.Pweree�euw,ear eD.P.v nulns... " / TOTAL DUE ,– 7 PREVIOUS CREDIT MANIFEST CODE SEO # r . yrsA DO NO I VrHI TE IN THE AREA BELOW CARD Pnnl Customer Name By a F7 AMEX FX -.DAIE VISA MC IN THE EVENT OF EMERGENCY CALL CUSTOMER REFERENCE771 Customers Authorized Representative THIS AGREEMENT CONTINUES ON THE REVERSE SIDE INFORMATION i I 1= .�, .. •' . u