COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

54UU Legacy Drive,CIUSter II,B3 800-669-5740 •�,, DUNS NO. 05-397-6551 FED.ID NO. 396090019 GUS IUMEH Plano,Texas 75024 wWw.safety-kleen.com CMS FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SCHEDULED SCHEDULED CUSTOMER NO. #�-�/ SERVICE WEEN TERRITORY 209-545-101 RALPH TORRES 08M00496907 C CODE S BALANCE B R U CREDIT PREVIOU T �_p)C GMEN CHAIN OAR SVC.P/C PROD,P/C J \\ SEEGMENT COUNTY M ' 23535 t3o 1�-D E LOCATION TAX EXEMPTION NO. R ��" 7b 718501 SER ICE ATE SALES AP N0. 6'w CUSTOMER P.O.NUMBER CUSTOMER PHONE# I TAX CODE DATE EQPT/PROD ORDERED I SERVICE TAX C.O.M.S.TAX PRODUCT TAX Q W SERVICE) SERIAL REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE awM;E MSDS DEPT PRODUCT NUM UNIT PRICE DUAN. CHARGE TAX CHARGE MIN. CLEAN SPENT 0OF SK DOT CC TERM SERViCETERM SCH DATE CODE PROMO NO, GIVEN CONI. WEEKS INITIAL Iry M'1"4 2 ❑ 3 ❑ 4 ❑ 5 ❑ 6 7 ❑ g .. a •s¢ ❑ 9 _Eiw_ ❑ 0 ❑ 1 ❑ 2 ILI ❑ CHECK GOOD POOR YES NO YES NO TOTAL-SERVICE/PRODUCTS DO APPROPRIATE DECALS IN PLACE MACHINE PROPERLY GROUNDED F 7 BOXES MACHINE CONDITION ❑ ❑ AND LEGIBLE ❑ ❑ LOCAL PHONE NO.STICKER ❑ ❑ Z 8 CLEANLINESS FUSIBLE LINK ❑ ❑ AFFIXED TO MACHINE ❑ ❑ W U$EPKTRANSPOHTER 1 IDNO USEPATRANSPQRTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLY EMERGENCY INSTALLECLOSING SPENT SOLVENT MEETS c CONDITION ❑ ❑ OF LID UNOBSTRUCTED ❑ ❑ ACCEPTANCE CRITERIA ❑ ❑ 0 TXR00005093U 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12-CONTAINERS 13. TOTAL 14.UNIT SK DOT NUMBER 516 0 6 CERTIFY THAT MY TOTAL W NO. TYPE QUANTITY WT OL 1AASTE STREAMS ARE WITHIN /� y� ��/�• r� U �J /'1 (� c ��"',y.�- /'1 1n• �7� SAA /1(?' ONE OF THE FOLLOWING J • V`^ w� 'T l �•�•r Y'l� �) ✓y ` ` r'T �'1. ` I \J' I b �. OTO YIDRIES. 13: Z PL.S Y i' 220 las.TO 2.200 LBS./MO, Q INITIALS W n �• GREATER THAN 2.200 EB ONTH J O aC3 ). USINmALS Q m DESIGNATED FACILITY NAME AND ADDRESS —&Am 3N6,• ETHERIEINTHAT OMAATERIAL HAA EO-THECWASTE USA EPA ID NO Q i- ) MATERIALS OR IN THE PROCESS GENERATING THE CID STATE ID NO. WASTE MATERIALS. W.2 CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: .MANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND To BE BOUND BY THE TERMS AND TOTAL CHARGE ,,x� I V_o QNDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. FROM ABOVE) CHECK NUMBER ( ) F ❑TODAY'S SERVICEISALE 7 f•1S SE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE ❑PREVIOUS BALANCE AS FOLLOWS DICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. 3_;,.. Q L A ESSA DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) .d ; d INVOICE# AMOUNT$ INVOICE# AMOUNT$ GAO T m W m° ty mel m°e0o""`�rie°"'�°^B19°'B aOpM d w.PackN°em.'"°n'°°°"°lao°I°°•°"°'r°I� °°w`"""ar`°"°P"m'""' TOTAL DUE PREVIOUS MANIFEST CODE SEO# 3 t1"[" �� •^ ` _ CREDIT � 4 ( L � DO NOT WRITE IN THE ARE ELOW Print C TTstomer Names- AM M004969072 VISA IN THE EVENT • ' Mc LLLU By .� / 434406 EMERGENCY CALL CUSTOMER REFERENCE Cus om rs Au rued Representat ve INFORMATION �l l '•• •�