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JW 1301 Gervais Street - Suite 300 DUNS NO. 05-397-6551 FED. ID NO 396090019 CUSTOMER
<br />Columbia, South Carolina 29201 � t�
<br />FOR SERVICE CALL
<br />BRANCH MANAGER
<br />DOC. EXP.
<br />SCHEDULED
<br />SERVICE WEEK
<br />SCHEDULED
<br />TERRITORY
<br />eleen. CUSTOMER NO.
<br />0-9 1,8 01 UUa3354 44
<br />209 545 1,011, RALPH TORRES 06/28/03
<br />I �} 0 �" �a 7 0 1 � �9 2
<br />CREDIT I
<br />CODE PREVIOUS BALANCE OVER 60 DAYS
<br />�}BAL
<br />E 169151,®62. 14032.71
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<br />1'9L t' Al�i� �k 9,L 0002-3854a67�
<br />CAL TRANS D I V I S T O N TEN
<br />SINE
<br />BUTYPESs CHAIN COUNTYOUTER I SVC. P/c PROD. P/c
<br />916 01000 N0 I.Q46310001
<br />03 ' ;s S,T PO BOX 1,632
<br />LOCATION TAX EXEMPTION NO.
<br />® EQUIP DIVISION STOCK"°(ON CA 95206
<br />?185[11,
<br />STO KTON CA 95205
<br />SERVICE DATE I SALES REP N0. CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE HANDLING ASSOC.
<br />CODE CODE SERVICE TAX C.O.N1.S. TAX PRODUCT TAX
<br />�r -341 c AUO'9 209 948 781,3 05 1,95-;848? Pw s 0775 ;?'?5
<br />SERVICE/ a REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE CHANCE .INV. PROMO MSDS
<br />DEPT QUAN. CHARGE CC SERVICE TERM SCH. DAE
<br />TAX CHARGE MIN. #OF TERM p r' GIVEN
<br />PRODUCT'^ "' UNIT PRICE CODE NO. RELEASE
<br />U M 1[ t E CLEAN SPENT CONT, SK DOT (WEEKS)(INITIAL) 0Y WW) 4 � L EASE 9 V O 8
<br />115X81 1 12
<br />❑
<br />2i"x'901830,x.;0'19773 1 914.50 7.3 101.82 0.00 1, 9$x}1, 4
<br />El8200003.9775
<br />31 `1# 50 7.32 101.8 0.001, 9,41, 4
<br />. 90 0 1 or, 5.909 0000 0
<br />❑
<br />El
<br />El
<br />❑
<br />194.90 14.64 -� � CHECK GOOD POOR YES NO YES NO
<br />m
<br />s DECALS IN PLACE MACHINE PROPERLY GROUNDED
<br />TOTAL-SERVICE/PRODUCTSAPPROPRIATE ❑ ❑
<br />MACHINE CONDITION AND LEGIBLE _
<br />❑
<br />H
<br />z
<br />,.: BOXES LOCAL PHONE NO. STICKER
<br />- - &CLEANLINESS FUSIBLE LINK ❑ AFFIXED TO MACHINE ❑
<br />W
<br />,
<br />USEPA TRANSPORTER 1 1O NO,. USEPA TRANSPORTER 2 ID N0 GENERATbR USEPA,ID NQ _ E GENERATOR $T/�TE ID -:NO LAMP ASSEMBLY ❑ SPENT SOLVENT MEETS
<br />EMERGENCY CLOSING
<br />CONDITION ❑ ACCEPTANCE CRITERIA ❑
<br />X £3 Q + i [3 aQ 9 ', OF LID UNOBSTRUCTED
<br />Tl�',,.��I.�C,S..� ��,Lz CAD982501,?6 9�9Y3��?6r10740
<br />DESCRIPTION
<br />N
<br />11. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.)
<br />12. CONTAINERS
<br />N
<br />TYPE�A
<br />73. OTAL
<br />UA TI
<br />74. UNIT
<br />SK DOT NUMBER
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<br />1 CERTIFY THAT MY TOTAL
<br />WASTE STREAMS ARE WITH(
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<br />t u ��'.. LF. L di 9`3:L i' k.", �,� L'yf tt tJ N D '! S' i V e .A. f'S 8N 8 L L.:X li 1. D l iY O 8 LD i! T ®7 i,..
<br />,Ary 99 A� y hry,, ryry y° $�figg LIQUID
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<br />ONE OF THE FOLLOWIN
<br />CATEGORIES.
<br />"'':) RE6, 1LATED) AQUEOUS PARTS WASHER SOLUTIO (8v3 GAL)
<br />�
<br />�
<br />0TD22UL6S./MONTH
<br />z
<br />-.
<br />INITIALS
<br />Y
<br />'
<br />220 UB •02;20 LBS./MONTH
<br />j
<br />a
<br />...
<br />-
<br />W
<br />-
<br />-�
<br />GREATER THAN 2,200 LBS)MONTH
<br />�C
<br />"'
<br />3 2
<br />,-L
<br />INITIALS
<br />cc
<br />DESIGNATED FACILITY NAME AND ADDRESS A {� L
<br />�) T i
<br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID
<br />g q q y{ 9 Y7
<br />NO. A 9 t, LI i '6 t Ci i7
<br />Z a
<br /><!�
<br />EITHER IN THE CHARACTERISTICS OF THE WASTE
<br />CAT00061a9,i
<br />UJ CC
<br />50`50J �" I \ °'" h
<br />i1. LL1) aAl.;A
<br />C 9568
<br />MATERIALS OR IN THE (PROCESS GENERATING THE
<br />WASTE MATERIALS. STATE ID NO.
<br />1 AGREE TO -PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND
<br />CONDITIONSSETFORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT.
<br />PLEASE CHARGE MY ACCOUNT FDR THIS TRANSACTION UNLESS OTHERWISE
<br />CASH
<br />TOTAL RECEIVED APPLY PAYMENT TO
<br />"�, +.
<br />;di71ANIF S�N�? r Y� l ,w
<br />TOTAL CHARGE
<br />(FROM ABOVE
<br />�)-
<br />CHECK NUMBER
<br />❑ TODAY'S SERVICE/SALE
<br />,,} j , �J Z._
<br />>lY
<br />®
<br />❑ PREVIOUS BALANCE AS FOLLOWS
<br />INDICATED IN T79 PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS
<br />DOCUMENT IS DULY UTHORIZED TO SIIIGN AND BIND CUSTOMER TO ITS TERMS.
<br />a to certi y tna u a named mate $e property c aselfied, packaged, marked and labeled, and are In
<br />P'o'p
<br />Probe contliaon fo V nsporta on acro dl g dh app cahis r ulaeons of the Department of Transportation.-
<br />WASTE MIN.
<br />(FROM ABOVE)
<br />Q
<br />W d
<br />LDR MESSAGE
<br />INVOICE # AMOUNT $ INVOICE #
<br />®
<br />AMOUNT $
<br />F
<br />L D R' NOT T R E Q D
<br />TOTAL DUE ?
<br />MANIFEST CODE
<br />SEQ #
<br />PREVIOUS _._
<br />C msA
<br />DO NOT WRITE IN THE BELOW
<br />CREDIT
<br />CARD NO
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<br />By
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<br />epres$ntative
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