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5400 Legacy Drive,Cluster Il,B3 800fi89-5740 DUNS NO. 06-3976551'` FED.ID NO. 396090016 CUSTOMER T T. <br /> Planww <br /> Plano,Texas 75024 w .safety-kleen.crom FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SCULm LE <br /> CUSTOMER NO. SERVICHEDE WEEK SCHEDULED <br /> TERRTDRY <br /> U <br /> 2Q9-515- 11] I RCI .N A T 08/26/06 OF- 24 00211561 <br /> 0 0 U L - 9 2 1 7 _ 1 c CREDIT PREVIOUS BALANCE <br /> S CODE <br /> E 116. 0 1.16. 01 <br /> cHwN Plc PR <br /> T U ld i L E`TE R BUSIN OUTER Svc. OD.PTC <br /> O ' 1400 WATERLOO ROAD TYPE COUNT <br /> M 09 0 3O NO 3'14 414 <br /> E RTTN TON NOACK LOCATION TAX EXEMPTION NO. <br /> SERVICE DATE JSALESREPNO. CUSTOMER P.O.NUMBERHANDuxc Assoo. 718..01 <br /> CUSTOMER PHONE# TAX CODE CODE caDE SERVICE TAX C.O.M.S.TAX I PRODUCT TAX <br /> 14 3o-OG 7q j yr Q , a z 01� 2U9-466-9580 OS-195-84ES7 08 08 - 0 <br /> DEP1 SERVICE! SURVEY E f SALES TOTAL-. WASTE SOLVENT/DRUMS SERNCE CHANGE DNWE <br /> PRODUCT NUMBER UN11f11Tp�31T£ICE DUAN' CHARGE TAX CHARGE MIN. EAN SPENT °OF CC SERVICE TENM swogTe Ixv, PROMO MSDS <br /> DaR. SK DOT TERM qY CODE No. RELEASE NO, GIVEN <br /> O: 100009 1 1s. 0 0. oc 1.5. 0 - 0. or o ❑ <br /> 2 0: 88888 02127651 308. 000 J > 12 ❑ <br /> 3 - ,�SS� 33tg (� 1 6 3 -s- ewe - ❑ <br /> a , <br /> 5 ,N¢Paayiie, t ❑ <br /> 7 ❑ <br /> 70 ❑ <br /> 17 ❑ <br /> 12 "t r —0 — ❑ <br /> CHECK GOOD POW WS <br /> El <br /> TOTAL-SERVICE/PRODUCTS DECALS IN PLACE Es xD <br /> _ APPROPRIgTE /MCNINE PgDPFALY GROUNDEDBO%ES MACHINE CONDITION ❑ ❑ PIID LEGIBLE ❑ E] NO <br /> ❑ ❑ h <br /> BCIFANLINESS FUSIBLE UNK LOCMPHONE ND.STCNBi Z <br /> USEPA TRANSPORTER,11DN0. USEPATRANSPORTER21DNO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. RSUGLEO ❑ ❑ ^PATO MAcwNe ❑ ❑ W <br /> LAMP g55EFffiLY <br /> 1'Xf?000U5093U c.:AD11S092U'!; CONDIDDx ❑ OFUDUNOBSTRRGCNTED ❑ ❑ MCCMANCVECIMIPRRA ❑ ❑ <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID. +z.co aNERs +a TOTAL W.uxIT <br /> N E NTTY WT L SK OOT NUMBER dld3( WA9�STP MS ARE WITHIN LUr'1 ONE OF THE FOLLOWING <br /> GTEGORE& <br /> lJ r 7 OT0220LBSJMONTH Q <br /> R17��Y�� -TM <br /> NRAS �V <br /> 2MUIS.TO 2.200 UISJMONt9 <br /> a <br /> -- / <br /> IN W <br /> GSEgT:q TUN 2,200 LBS,RADNRi LU <br /> O <br /> DESIGNATED FACILITY NAME AND ADDRESS INITs 00 <br /> MI <br /> I CERTIFY THAT NO MATERUL CHANGE HAS OCCURPED USA EPA ID NO. Z <br /> EITHER IN THE CHARACTERISTICS OF THE WASTE Q Q <br /> M4TERWS OR IN THE PROCESS GENERATING THE <br /> WASTE naTERULs. STATE ID NO. W <br /> CASH ❑ TOTAL RECEIVED APPLY PAYMENTTO: MANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMB AND TOTAL CHARGE <br /> CHECK NUMBER TOWVS SERWCEIPAIE [/ n- CONGRR S SET FORTH ABOVE MIO ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) <br /> ❑ -„o/ � � � } 2 PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br /> ❑PREMOIIS BMgNCEAG PoLLDW$ INDICATED IN THE PAYMENT RECENEU SECTION.TIE INDMDUM SIGNING THIS WASFROMTE MIN. W a <br /> LDR MESSAGE DOCUMENTIS DULYAUTHONIZrnm SIGN AND BIND CUSTOMERTO TSTERMS (WASTEFROM IN. <br /> INVOICE# AMOUNr$ INVOICE# AMOUM$ LDR NOT REQ D '^+•®•�^NH+II,..ms,w�m,,,v.I.e..POP.nyy ym,P.uoy.a,,,.,lue.rq meyy.b.,H <br /> # P�9afmaYm McYyahhbma-�Wg NobePalm.nw.son.NN.DA..,,�ga,,.,> a' <br /> MANIFEST CODE BED TOTAL DUE <br /> PREVIOUS ______ I I <br /> CREDN y 5 D ` n / / - DO NOT WRITE IN THE AREA BELOW <br /> MCA 0032115614 <br /> AMIX <br /> CUSTOMFR RFFFRPMr.9 By n.w.......+ � 0001-9217-19 –4 <br />