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C <br />T <br />C <br />N <br />E <br />F <br />A <br />B <br />C <br />D <br />ANW 1301 Gervais Street -Suite 300 ��� DUNS NO- 05-397-6551 FED. ID NO J 396090019 CUSTOMER <br />'WE3 I <br />Columbia, South Carolina 29201 t <br />FOR SERVICE CALL <br />! <br />BRANCH MANAGER'! <br />DOC. EXP. <br />SCHEDULED SCHEDULED <br />SERVICE WEEK TERRITORY <br />atekpkleeu. CUSTOMER NO. <br />03-18 011 0023354245. <br />209 545-1011; RALPH TORRES I 06/28//3 <br />0 1 0°.:a 3 7 0 1 Ws 2 <br />CREDIT <br />CODE PREVIOUSBALANCEL OVER 60 DAYS <br />E 3l�9513.'9�32 i4l132.73 <br />3flac`�. 67 <br />CAL °9�ANN SHOP 1 0008-3854-67; <br />BUSINESS TYPE <br />TER <br />CHAIN COUNTY <br />SVC. P/C PROD. P/C <br />�3pEpy5�4 <br />� 7gg� TEN <br />TRAWS A [U y U I V I S 1 V N TEN I <br />ni. <br />nnnn NO1036110001 <br />1603 S F `»,'� PO BOX 1,632 <br />1603 <br />LOCATION TAX EXEMPTION NO. <br />r1QUSH VISION ®STOCKTON CA 95206 <br />® <br />® <br />STOCKTON CA 95202 <br />71385011 <br />SERVICE DATE SALES REP N0. CUSTOMER P.O. NUMBER CUSTOMER -PHONE # TAX CODE H code G CODE* SERVICE TAX C.O.M.S. TAX PRODUCT TAX <br />/12A0029 209 48-7813 05-195-8487 p .91775 60775 <br />SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE CrMGE INV. PROMO <br />DEPT DUAN. CHARGE CC SERVICE TERM sctGaTe <br />MSDS <br />PRODUCT UNIT PRICE TAX CHARGE MIN. sor TERM CODE N0, <br />N U 1 $ 9 E � CLEAN -SPENT CO�TNT. SK (WE11 WMRELEASE tY O � <br />GIVEN <br />t- ^7 q°y r* r {� �T g^p yD�OT �g { p <br />5 0 I.�i1.t1 Ley 3 1 <br />#� 8 xis a �'. 7 2 4= o 0 5 56.25 <br />,..i "1 � i- n S 9 ri Com.; <br />❑ <br />g"4d <br />¢I-qf <br />S,'=.� 1A FI i. a01t!2'res82!E `5 210 4 705 - 5Cti 2.�.'A 0.00 1 8139 `R <br />❑ <br />1 5.90 I X9 .1 5.90 0.00 1 0 <br />❑ <br />El <br />El <br />El <br />El <br />El <br />GOOD POOR YES NO YES NO <br />1< 1r <br /># DECALS IN MACHINE PROPERLY GROUNDED <br />® <br />TOTAL APPROPRIATE MACHINE CONDIT ON AND LEGIBLE ❑ <br />❑ <br />Z <br />BOXES & CLEANLINESS -; FUSIBLE UNK ,LOCAL PHONE M STICKER <br />• ❑ AFFIXED TO MACHINE ❑ <br />W <br />INSTALLED <br />`.. - ., ,; , . ;, ., _ , , ., . d3 s� <, <br />USEPA I RANSPORTE�i 1 1D N0 USEPA TRANSPC)RTER:21D N0a) NE 70R USEP fD NO s� �GENRATOFi ST T I NO LAMPAssEMBLvj EMERGENCY CLOSING SPENT SOLVENT MEETS <br />CONDITION ❑ ACCEPTANCE CRITERIA ❑ <br />1 � CO �,� OF LID UNOBSTRUCTED <br />T,� „r�;�05� f �' CA➢9t�2S�i1,736 HY.H�360074�i l <br />� <br />o; <br />- <br />. MY• TOTA <br />11 12. CONTAINERS 13. TOTAL 14UNIT I CERTIFY THAT <br />US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) SK DOTNUMeER 5 6 � 55 <br />W <br />No. PE QUANTITY oL • WASTE STREAMS- ARE WITHIN <br />7AZA"DOUS WAST ,% LIQUIYvN,O8Sa g NAry 82 PlII <br />OF <br />I�0 <br />G <br />839 <br />17. <br />ONE OF THEFOLLOWIN <br />CATEGORIES. <br />0 TO 220 LBSJMONTH -. <br />7Ur39)(ERG 17 )AQ3EOLfS BRAKE SOLUTION i8.3 GAL? <br />` <br />o <br />Z <br />- <br />INITIALS <br />(, <br />220 LBSyTO.2;200 LBS./MONTH- <br />0) <br />NWAL-&^"' <br />W <br />J <br />GREATER THAN 2,200 LBSJMONTH <br />Lf <br />INITIALS <br />® C <br />�+ r �y �✓ <br />DESIGNATED FACILITY NAME AND ADDRESS S A F L I{ K L <br />pt g� pg <br />E r y S Y S T E j g S °y ' I KI C® <br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID <br />p gry gy g•g •ry gy �g ry <br />NG. C,A 0 0 3 1 0 0 G, 4 5 1 f <br />Z G <br />EITHER IN THE CHARACTERISTICS OF THE WASTE <br />42 <br />C g, 0 0 0 0 0 ry. <br />4. W, t,.8 i.J '!a iJ LJ � 4�� 5 <br />^ t !'® r^ <br />"± r`9 r'e fl it °"^ STREET <br />6131101011 <br />6 iJ y:3 L✓ 3 1,•3 T� a .s D E E 8 SACRAMENTO <br />g� �g •°y jq° <br />C A 9 5 8 2 �. <br />MATERIALS OR IN THE PROCESS GENERATING THE <br />WASTE MATERIALS. .STATE ID NO. <br />AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND <br />CONDITIONS. SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. <br />PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br />W G <br />• <br />CASH ❑` <br />TOTAL RECEIVED <br />APPLY PAYMENT TO <br />�MANIF'EST NO I+' a <br />j' "'` " ' ` "• `"` "'�' '" " "' ! <br />TOTAL CHARGE' <br />- (FROM ABOVE) <br />`- 1 . <br />U r <br />>I - <br />CHECK NUMBER <br />- <br />❑ TODAY'S SERVICE/SALE <br />Z -Z t � j <br />�' 0 <br />® <br />❑ PREVIOUS BALANCE AS FOLLOWS <br />INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING. THIS <br />DOCUMENT IS DOL TO SIGN AND BIND CUSTOMER TO ITS TERMS. <br />This is to certly That above -d! me are propedy Iasallled, packaged, marked and labeled and are In <br />a el o applcab aWlbre of the DeperMlenl of TrereporleUon.° <br />WASTE MIN. <br />(FROM ABOVE) <br />W 0 <br />N <br />LDR MESSAGE <br />INVOICE # AMOUNT $ INVOICE # AMOUNT $ <br />j b? t p <br />9propeponalbn <br />TOTAL DUE <br />0�lf <br />� ^-�J wte <br />PREVIOUS <br />MANIFEST CODE SEQ # <br />DO NOT WRITE IN THE AREA BELOW <br />CREDIT <br />4 <br />CARD NO <br />9. <br />€ U <br />not Custom r Name <br />ui <br />0023354245 <br />CARD NO. EXP DATE <br />AME <br />X <br />vlsA" <br />. ' <br />ir;r•000oCREDIT <br />� <br />MC <br />BV <br />CUSTOMER REFERENCE`;,.„,.. <br />p entatlye <br />Custome I Authorized Re res <br />