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1301 Gervais Street-Suite 300 DUNS NO. 05-3916551 FED.ID NO. 75-2198928 l"lw i V'VI.K <br /> Columbia,7 �..arolina 29201 - FOR SERVICE CP BRANCH MANAGER DOC.EXP. SCHEDULED swSouLEo ��7�7�}�� F <br /> ! s}CUSSI ER NO. ' +� SERVICE WEEK TERRRORY " „ • <br /> G`J-54Ci-1::J1I HnN'ICA SHANNON 1=_ /Ln/99 9q-14a <br /> C r f Ir— 1 Ac J — i. — 3 9 G CREDIT <br /> U CODE PREVIOUS BALANCE AL 60 <br /> ' <br /> S _ f. <br /> T PAYLESS FOR= 1-11% CAW. Pa= `'OI �-" `-'1 BUSNESS CULLER <br /> D. <br /> TYPE CHAIN DOOM SVC.P/C PROPIC <br /> o 26 h CHEROK �l� Y�f� <br /> E • L O D I CA 9 S r'4 J • LOCATION TAX EXEMPTION NO. <br /> R 7Za Si.' <br /> SERVICE DATE SALES REP NO. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE HANDLING Assoc. SERVICE TAX YC.O.M.S.TAX PRODUCT TAX <br /> CODE CODE <br /> �_a7u—'+iLc —IRS—Ut-.98 . ''77r 7775 <br /> SERVICE/ 'S E R I AL PC V A L'I( i� _ _ <br /> DEPT SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE cXY1RE Ixv. PROMO MSDS <br /> PRODUCT r DUAN. CHARGE CC SERVICE TERM ux RML <br /> Nl.M 4i r i. ! T o K ;i.T TAX CHARGE MIN. aEAN SP=Nr �� SK DOT ERM :�_FKSInNITIAL aDf NO. RFL A r F �. GIVEN <br /> r.. 0 i ''+c - ❑ <br /> 2 ❑ <br /> 3 ❑ <br /> 4 <br /> 5 ❑ <br /> 6 ❑ <br /> 7 ❑ <br /> R ❑ <br /> 9 ❑ <br /> 10 - ❑ <br /> 11 ❑ <br /> 12 <br /> TOTAL-SERVICE/PRODUCTS 7E. �� n�;7.} 7.q�>ac rte :?: CHECK GOOD Poon vfs xD vEs NO <br /> DECALS IN PLACE MACHINE PROPERLY GROUNDS) <br /> APPROPRIATE ❑ ❑ z <br /> MACHINE CONDITION AND LEGI&E <br /> BOXES Is CLEANLINESS ❑ / LOCALPHONEMACHINE <br /> Z <br /> NSINSTALLK R. ❑ pEFgpO TO MACHINE f <br /> ❑ LLI <br /> INBTALLEO 1LJUS PA TRANSPORTER 1 D NO. USEPA TRANSPORTER 21D N GENERATOR USEPA D NO. GENERATOR STATE ID NO. LAMP ASSEMBLv cc EMEgGENCV CLOSING / ❑ SPENTSOLVENT MEETS /❑ GL"T�-1 -'7524coxOmOx OF UD NwOBSiHUI ACCEPTANCE CRITERIA Cr <br /> 1 t US DOT DESCRIPTION INCLUDING PROPER SHIPPING NAME,HAZAR 12.CONTAINERS 13. TOTAL Ia.LIND C' . O- - CERTIFY THAT MY TOTAL O <br /> _ ( rr ] No TYPE OUANTmr NTNOL SK DOT NUMBER - L. _ ] I1ASTECER SiflEAMS ARE WITHIN W <br /> ANTE RUST (r'TRnLE N!APHTPA ) NA1`193 i ONEG01,THECWFFOLLOW NG <br /> A. 'CII € I^ E nt'' E:•n_ Gt1 >c) <br /> `„- - U. 7L85lG AL E � o9ozzo LaslMONm O <br /> Z <br /> 3 wmALS Y <br /> 23 USISL IO2.2W 1BS.IMONTH <br /> W <br /> �. GREATER IRAN 3100 LB31MONTH J <br /> wRIALs QD <br /> DESIGNATED FACILITY NAME AND ADDRESS S A FS T Y—Kf— EN $ j TF AA1- I n�. C';� -1 THAT No MATERIAL CHANGE HAS OCCURRED USA EPA ID NO. A T lyO'61?416 A Z <br /> ERHER IN THE CHARACTERISTICS OF THE WASTE Q ir <br /> 5n Sv >AL.I CA. a.L Nr' SAL I A.t ' R C:6. G TER OR IN THE PROCESS GENERATING THE STATE ID NO. C It T ^ 1L-4-!65 W <br /> MATEPIALS. L•�! 6 <br /> CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: MANIFEST NO. ICUstomees <br /> TO P VE CHARGES AND To BE BOUND Br mE TERMS Ano TOTAL CHARGE V m <br /> _ NS SET FO. OVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. <br /> HE K NUMBER (FROM ABOVE) <br /> �' SERVICESALE HARGE MY A IN <br /> FOR THIS TRANSACTION UNLESS OTHEHY/ISE , �� <br /> PREVgNG OAIANCE AS mums D IN THE PAYME CENEO SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. W C <br /> LDR MESSAGE ISDULY AUDEEK EO SIGN AND BINO CUSTOMER TO US TERMS. (FROM ABOVE)INVOICE# AMOUNTS INVOICE# AMOUNTS n• ^LDR RF .. €? w.. �.P�.� ..sa�<ool.�b,.wl.e.,.alA.o.�.�I,.I:aT,.�.00.•bl,� TOTAL DUE <br /> PREVIOUS _ MANIFEST CODE SEO# Y— ��CREOR "CARD NO .� /r% r' �G' % DO NOT WRRE IN THE ARFL BELOW <br /> stomer Name 'AMEX yVISA <br /> Mc > . ✓'' 4' _�� 7_ a 5_ ,7:-J 9!TOMER REFEREW� /- amefs Amhpri2e0 Representative' <br /> "MATION " •' THIS AGREEMENT CONTINUES ON THE REVERSE SIDE <br />