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Legacy Drive,Cluster II,B3 800-669-5740 DUNS NO. 05397-6551 FED,ID NO. 396090019 CUS I OMEN WjE CARk Plano,Texas 75024 www.safety-kleen.com ` X FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SCHEDULED SCHEDULEDREFERENCE CUSTOMERNO. SERVICE WEEK TERRITORYNUMBER 209 -545- 101 . RAI.PFI TORRL•'S 08 M004937216 C CREDITPREVIOUS BALANCE YS CODE T S N �QJ F v� uSTOME CHAIN OUT SVC.P/C PROD P/C rS ll II '' SEGMENT COUNTY 2335 M LOCATION TAX EXEMPTION NO. R Vit X r A q 9 718501 SERVAE WEJSALEAREP N0. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EQPT/PROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX 01568.1 Pint SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE cwNcl MSDS DEPT QUAN. CHARGE CC INV PROMO PRODUCT NUMEIER UNIT PRICE TAX CHARGE MIN. CLEAN SPENT "0F SK DOT TERM SERVICE TERM scHOATL coOF NO. CONI WEEK INITIAL M"Wwl GIVEN L ,,_ d, ❑ 2 ❑ OCI ❑ 4 ;•;Ne RecYcie. ❑ 5 L. �) ❑ 6 ❑ 7 a,, r ❑ B uh; ❑ 9 Wn EnA` ❑ 0El 1 El 2 CHECK GOOD POOR YES NO YES NO _ DECALS IN PLACE MACHINE PROPERLY GROUNDED TOTAL-SERVICE/PRODUCTS Co APPROPRIATE MACHINE CONDITION AND LEGIBLE ❑ ❑ ❑ ❑ H L' C. J (j 1' Z' BO%ES g CLEANLINESS ❑ ❑ FUSIBLE LINK LOCAL PHONE M STICKER w INSTALLED ❑ ❑ AFFIXED TO MACHINE ❑ ❑ USPATRANSPORTER 1 ID NO, USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. — / AMP ASSEMBLY ❑ ❑ EMERGENcvcLoslNc SP ENT SOLVENT MEETS CONDITION ❑ ❑ ACCEPTANCE CRITERIA ❑ ❑ T X R 0 0 0 0 5 0 9 3 0 �' '7 OF LID UNOBSTRUCTED (� 12.CONTAINERS 13. TOTAL 14.UNIT 516 3 �j CERTIFY THAT MV TOTAL W 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) SK DOT NUMBER y� NO TYPE QUANTITY WTNOL ASTE STREAMS ARE WITHIN H A-L1W60 to S G� �t"E r L 10 u 1 D , N • O .S. C �� Q—61y) I Gt M l_ff AW) CATEGORIES ONE OF HE FOLLOWING L.rD •� 0 TO 220 LBS/MONTH O. �1 AZ A 1,15 . LLQ/'1'S T E I S("i(_l pall INITIALS V 3 220 LBS.TO 2,200 LBS./MO, a INITIALS W f, GREATER THAN 2,200 LBS./MONTH a O? to N CD INITIALS Q DESIGNATED FACILITY NAME AND ADDRESS SAFETY-KLEEN SYS`T'EMS� INC• ETHERI�NHTHE OHMATERIAL ARACTERSTCSEOFATHHECWASTE USA EPA ID NG---, Q� MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. N WASTE MATERIALS. W CASH ❑ TOTAL RE EIVE AP LY PAYMENT TO: ANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE —o CHECK NUMBER CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) 5 H.. ❑TODAY'S SERVICE/SALE r " < 'r PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE = ❑ PREVIOUS BALANCE AS FOLLOWS INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. - W d ESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) � INVOICE# AMOUNT$ INVOICE# ! AMOUNT$N I •Thia 11 to candy that the aoove-arae notelet,are properly claim.Paa atjaa,marker and iaoaiaa and are.n proper ere uo for va sponaeon a«omm0 m me aPp able rae aeons of ma Depanmem of Transponeuon• TOTAL D U E CREDIT _--_________.i _ MANIFEST CODE SED# ` �n✓//� f !`� / DO NOT WRITE IN THE AREA B LOW CREDIT .--. __. li CARD NO 6 ..S'• // Print C stomer Name AMEX EXP DAT M0049 37 216 VISA ' 015681 -' N THE EVENT OF AN MC BEMERGENCY CALy , CUSTOMER REFERENCE Customer's uth d Repre five