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2800 North DOI Expromwey,Sutle 200 BOOfiE}57Q `— MI......n..' DONS NO.. 0538)4&,1 FED,IO 40.391050019 ` ELGIN OFFICE <br /> Ridumxl on,TX 750M M ...Fry-III.F.corn �V FOq SERVICE GU . BRANCH MANAGER DOC.EXP. <br /> SEIAi. ACUS1TOMEP NO. c_ ZO JS4SS0S1 Tor res• Ralph �ive9o:.9 <br /> C Q\ - - • d `•• S COOS PflENOUS BNANCE <br /> U /� <br /> 7 C-NwaV fr *rP v II j /LA��w� >2 '$44f, <br /> O `dLvn LJ y�Jc An'jt ryvC Var°wEr cHAm °" svc.PF FADp.P/C <br /> n•1G,r1?Lec CA gs137 -90@4 It � �/'� seOMLOCATION TAX EXEMPTION NO. <br /> SERVICE DATE S 0 CUSTOMER P.O.NUMBER CUSTOMERPHOI TAX CODE �f DA EQ"MROD ORDERED SERVICE TAX COWS.TAX PRODUCT TM <br /> �1 <br /> DEPT SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENTIORUMS SERVICE Im PROMO 305 <br /> PRODUCT UNRPRICE OUPN. CHARGE CC <br /> TAX CHAR1GE MIN. BKOOT TERM S °",'.' OOY NO GNEx <br /> 1 Y� V .VV ❑ <br /> 2 b S%& S1OT FW 6TI,QO yr AINIII ❑ <br /> 6 ❑ <br /> 5 ❑ <br /> 6 ❑ <br /> 7 ❑ <br /> 8 ❑ <br /> 9 El10 ❑ <br /> 11 ❑ <br /> 12 ❑ <br /> TOTAL-SERVICE/PRODUCTS .�pL aoPaaPw 60m uuxvu¢ NMMNPRarrtt.Eamx9eD ❑ ❑ <br /> B� N'y� mEm siEw�9wmmav ❑ ❑ ucwa wlm,wmsrcxu <br /> wsal uxP N FTONSPNE <br /> USEPATMNSPORTER 1 ID NO. USEPA TRANSPOI9TEfl 21D NO. GENERATOR USEPA ID NO. GENERATOR STATE 10 sruuO ❑ ❑ ❑ ❑ W <br /> DDxDna ❑ ❑ ,!O'.'nLSOWS s9lwxr NEErs <br /> aDU qj almuxossmucrzv ❑ ❑ 56BiME•-anE.v ❑ ❑ (G7 <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID,I 1E1O. TOT.NO TN. mi xuMem C� iii ry 85 <br /> aFS DF TNF PI 3 <br /> A. SPA var OOS�f Sk roYg BBryDM G <br /> z <br /> mM Y <br /> B. xauu.ro V <br /> ,Manx a <br /> N <br /> C. uvA IluxsFNus,NoxTx IN, <br /> a—_ <br /> DESIGNATED FACILITY NAME AND ADDRESS M. . <br /> LNIH3E USA EPA ID NO. _ <br /> INI ON�a. ¢ <br /> x Tau nue"`PFOOM GExAs Dccuaxm NEMNITS TTNE STATE Ib N . <br /> a <br /> OW <br /> CASH ❑ TOTRECUVEO APPLY PAYMENT TO: MANIFEST NO. I ASSES r0 TIFFFre <br /> RL <br /> THE ABOVF CHARSTS MT TO WE OCONO av TFE ENS.w0 TOTALCHAAGE 9L � /� V p <br /> CHECK NUMBER COrvomIXua SET FOnmw�u NSO ON mE P�xERFE SIDE OF IRIS oTFUMENT. (FROM ASCIEI �-I 014J Qti <br /> ❑iOMv59FRJILEEOIE PIFAINDIES o TME MY THIS .Ci NN UNIEaE OTT ISE <br /> ❑raEvquseMAvauwu9KF LOP MESSAGE ttCUMmr6a �OTFSFRRSSON O TO OoxaweNPOJSTa ENlOIFlF SS INS WASTEROMABIN. Ng <br /> (FROMA MIN <br /> MV010E4 AMGUNT$ INVDICEx AMOUNTS "" a p�. '.+*��.I.°,�" TOTAL bUE 2g'�0-• 513 <br /> IFERENCEFFETTTTT7 <br /> p..1 a h Le„ )(i rrL IU HIT11-111111 <br /> M6, ANM1Irpep flalKwxllaMa <br /> INPORMARON 3 AgREEMENT CONTINUES ON THE REVERSE SIDE <br />