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5400 Legacy Drive, Cluster 11, B3 800-669-5740 DUNS NO, 05.387 6651 FED ID NO. <br />Plano. Texas 75024 www. safety -Kill com <br />CUSTOMER NO. <br />c J � % <br />U I <br />S <br />T <br />O <br />M <br />E <br />R <br />SERVICE DATE SAE 13EfJ CUSTOMER P.O. NUMBER CUSTOMER PHONE A TAX CODE DATE <br />DEPT SERVICE; NUMBER REMARK puAN, CHARGE SALES TOTAL WASTE SOLVENT/DRUMS <br />PRODUCT UNIT PRICE TAX CHARGE MIN. C:EAN ENT SK DO1 <br />1 � <br />2 <br />z <br />5 <br />6 <br />7 <br />8 <br />9 <br />0 <br />T <br />2 <br />CUSTOMER <br />FOR SERVICE CALL BRANCH MANAGER <br />SCHEDULED—[ ... .. I ue0 • .c <br />BRIT Rv <br />10 �01111,1111- <br />M <br />CREDIT <br />CODE PREVIOUS BALANCE I <br />CHECK LOGO POOR YES <br />APPROPHATE DECALS WPLCE <br />MAC E COnGTIGN AND LfGa E <br />205-545-11G11 RALpH TORRES <br />• EFiT CHAIN Ou Ery <br />SVC. PiC PROD P,C <br />DOC. EXP. <br />SCHEDULED—[ ... .. I ue0 • .c <br />BRIT Rv <br />10 �01111,1111- <br />M <br />CREDIT <br />CODE PREVIOUS BALANCE I <br />CHECK LOGO POOR YES <br />APPROPHATE DECALS WPLCE <br />MAC E COnGTIGN AND LfGa E <br />NO YES NC <br />❑ MozwdPRUPERLYGROUWW — <br />lJ <br />• EFiT CHAIN Ou Ery <br />SVC. PiC PROD P,C <br />3OXEs ❑ <br />1 TAX EXEMPTION NO. <br />IOD ORDERED <br />SERVICE TAX <br />C O.M.S. TAX <br />PRODUCT TAX <br />QEN TQR $TATE IQ NQ. <br />• CLFAEahi55 cU56LE LM <br />III <br />"� LAMP AssEMar <br />❑ AFFOFD Tu MAi1YME ❑ <br />Uj <br />SERVICE CaIANOE 0*0 - <br />TERM BEFINICE TERM LCR WR CODE <br />wccrci..nw, n wrri <br />pgpplp <br />NO. <br />CA I O <br />MSOS <br />GIVEN <br />TOTAL- SERVICE; PRODUCTS <br />CHECK LOGO POOR YES <br />APPROPHATE DECALS WPLCE <br />MAC E COnGTIGN AND LfGa E <br />NO YES NC <br />❑ MozwdPRUPERLYGROUWW — <br />lJ <br />3OXEs ❑ <br />LUCAL PHUhf Nu 5TfAhP <br />2 <br />U Q. <br />USEPA TRANSPORTER 210 NO. GENERATOR USEPA 10 NO. <br />QEN TQR $TATE IQ NQ. <br />• CLFAEahi55 cU56LE LM <br />III <br />"� LAMP AssEMar <br />❑ AFFOFD Tu MAi1YME ❑ <br />Uj <br />CA I O <br />/ (p O <br />EMERGFRCY cLOSWG <br />C1NDf�i0fi ❑ DF LD WESTRUCTW <br />SPENT sG VERT MEETS <br />❑ ACCEPTAWA CRITERM ❑ <br />�w <br />V <br />11. U OQT C TI N 04G R P=ING D CLASS, AND ID.) <br />• <br />12. <br />ANEFIS <br />13. TOTAL <br />T4. UNIT <br />SKgQrn MBlANO <br />1 TNA MY TOTAL <br />LU <br />TYPE, <br />WASTE IRREAMS ARE WITHIN <br />tF'-CFIi.ORCJr-.'ENZOTF<IFLUGRIDE) 3 UN1993 PG <br />III Wool) <br />� <br />' <br />ONE OF THE FOLLOh,r.G <br />' " a 5 <br />O TO 22D L89lMONTH <br />O <br />Z <br />IN.TI,�iS <br />Y <br />220uw T02300LISS.MONTH-T <br />Q <br />X � <br />N <br />NRWS <br />� n0 <br />GkEATER IRW P.25D iiS,�SFOFIM <br />Q <br />O <br />_ <br />DESIGNATED FACILITY NAME AND ADDRESSG:f <br />_ _ _ <br />+ , <br />• <br />ihiTL4y�_ <br />Q <br />�e ' <br />I CERTLY THAT NO MATERW. CHANGE HAS OCCURHEp <br />EITHER W THE CHARAMENSTICS OF TME WASTE <br />USA EPA ID NO. i ? <br />V <br />Q <br />'2 •' /O C' JL T'1�o tj t "TL 1; 16o <br />76 � o <br />MATERHLS OR IN THE PROCESS GEF.ERATWG THE <br />STATE ID NO. <br />)e , Z <br />Ac 7 �4 <br />u% <br />CASH ❑ TOTAL RECEIVED <br />APPLY PAYMENT TO: <br />MANIFEST NO. <br />WASTE MATERIALS. _ _ <br />I ACREE TO PAY THE ABOVE CHARGES AND TD BE BOUND BY THE TERMS AND <br />TOTAL CHARGE <br />.. <br />V o <br />CHECK NUMBER <br />❑ TODAY'S SERVICElSALE <br />—G—T <br />Q�•�U % S <br />CONDITIONS SET FORTH ABOVE ANO ON THE REVERSE SIOE OF THIS DOCUMENT <br />PLEASE CHAA E MY ACCOUNT FOR THIS TNViSA(.'TION OTHERWCSE <br />(FROM ABOVE) <br />OF <br />r <br />❑ fw Y1066 BALANCE AS MUMV5 <br />Q <br />UNLESS <br />INUICATED IN THE PAYMENT RECEIVED SECTION THE NomDUAL SKSNING THIS <br />WASTE MIN, <br />CC¢ <br />LUQa <br />• <br />LDR MESSAGE <br />DOCUMENT IB DULY AUTHORIZED TO SKIN AND &NO CUSTOMER TO ITS TEEMS <br />(FROM ABOVE) <br />N <br />INVUICt ♦ AMOUNT f INVOICE I AMOUNTS <br />'lir . �, LAM Yr I�r ru..,.�r� nv� n P+M✓•M a�4e Pa.pl. .nrru Mc Ytw�I. �Y w n <br />""""'�`".,""a'°"°"`=o""„""`>�",,.'W",."'°'�"""„"""",.`"• <br />TOTAL DUE <br />PREVIOUS - . _ _ <br />MANIFEST CODE <br />SEO (, <br />CREDIT � <br />���� � I �n <br />/ <br />lX] NOT WRITE IN THE AREA BELOW <br />CARD Nn <br />t <br />Print C Naar <br />(I"iillU' UESC���4 <br />CREDIT CARD NO, EXP. DATE <br />AMEX <br />L=LLIE <br />v ISA <br />nTTI <br />IN THE EVENT OF AN <br />Mc <br />'i <br />, ,1-, <br />CUSTOMER HtFEF4ENCE <br />EMERGENCY CALL <br />G,sluners Auvwrued RepesentaLYv <br />INFri iMATd''N <br />I <br />