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C <br />L <br />C <br />N <br />E <br />F <br />A. <br />B <br />C <br />D <br />r %yiin <br />Piano, Texas 75024 www.safety-kleen,com <br />A 7X7 <br />FOR SERVICE CALL <br />BRANCH MANAGER <br />DOC. EXP. <br />SCHEDULED <br />S <br />SERVICE WEEK <br />SCHEDULED <br />S TERRITORYJIM <br />me <br />CUSTOMER NO.b <br />20S3 --!545---10i I <br />RAI -PH TORREq <br />03/1.3/14 <br />10.- 2 01 2040684-5 57 <br />'.1 4 0 <br />CREDIT <br />rl . I I <br />"i OV2100-­8082--82 <br />ODE I BALANCE <br />�C PREVIOUS BAL. OVER 60 DAYS <br />SNOW Cl -NIRS <br />CUSTOMER <br />T <br />!S�G �.F N <br />OUTER <br />CHAIN 'CL.N. <br />SVC. P/C <br />PF1'qD P/. <br />3e W SONORA ST PID BLOYX 1849 <br />G`T13flK_T'(]N CA !3TOCKTGN CA 9 5 2 01 <br />TAX EXEMPTION NO. <br />0 <br />SERVICEJDAT� NOg CUSTOMER P.O. NUMBER DATE EQq ROD ORDERED SE�fiyICE TAX C.O.M.S. TAX PRODUCT TAX <br />/P <br />h, 1 744 <br />SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/ RUMS SERVICE CHANGE CHANGE IVISD <br />DEPT DUAN, CHARGE cc SERVICE SCH DATE Nv. PROMO <br />—CL ----N <br />TER NO.GIVE[ <br />UlQqui -UNIT PRICE TAX 9,LLAFI IN. M ODE <br />_Q� M ]SPENT NT (WEEKS) (INITIAL) YY Ww) <br />" CONT. <br />ft" 1� t$ <br />ff <br />ITT L <br />E] <br />❑ <br />El <br />El <br />El <br />El <br />7 "'7_0 <br />El <br />YES NO YES NO <br />CHECK GOOD POOR DECALS IN PLACE ❑ <br />TOTAL-SERVICE/PRODUCTS 7' APPROPRIATE MACHINE CONDITION❑❑ AND LEGIBLE E:i o MACHINE PROPERLY GROUNDED ❑1:1 1:1 <br />V.0 <br />-1 BOXES & CLEANLINESS FUSIBLE LINK LOCAL PHONE NO. STICKER <br />❑ E] AFFIXED TO MACHINE 1:1 El <br />z <br />LU <br />INSTALLED <br />UMTMWZA�l 4 E[:USEPA TRANSPORTER GENERATOR STATiflD NO. LAMP ASSEMBLY ❑ SPENT SOLVENT MEETS <br />El F-1 <br />• EMERGENCYCLOSING <br />CONDITION OF UO UNOBSTRUCTED ❑ ACCEPTANCE CRITERIA D' 1:1 <br />Ei o <br />LIU 1��IN%4NR �,�AZfl%QWS A, <br />PTION �INSK <br />COCON= <br />13. TOTAL <br />14. UNIT <br />DOT NUMBER <br />I CERT FY THAT MY TOTAL <br />w <br />NO. <br />QUANTITY <br />Y VOL <br />WASTE STREAMS ARE WITHIN <br />E-j"HYL.ENF.',) 6,. 1. Lit-42"�11 01 PG1 I I (ERG#�A, 153) F-002-1 D007, D12429, D039g, D040 <br />ONE OF THE FOLLOWING <br />CATEGORIES. <br />0 TO 220 LBS./MONTH <br />0 <br />z <br />INITIALS <br />220 LBS. ,200 UBS./MMrH <br />--INITIALS <br />LU <br />_J <br />GREATER THAN 2,200 LBS./MONTH <br /><L <br />Ch C <br />INITIALS i <br />N 9 Y SFFE M q. P I e - <br />DESIGNATED FACILITY NAME AND ADDRESS 3": fl <br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCUR USA EPA ID NO. Z� <br />STHE <br />F <br />60001 HfilH GTREETI SACRAMENTO CA 95828 EITHER IN THE CHARACTERISTICS OF WASTE El < I( <br />e 47 <br />MATERIALS OR IN THE PROCESS GENERATING THE X. r7i' ti eit 5 t <br />I STATE ID NO. Lu, <br />WASTE MATERIALS. <br />-CASH <br />-CASH El TOTAL RECEIVED APPLY PAYMENT T0: MANFEST 'NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERKOjiAND TOTAL CHARGE <br />CONDITIONS SET FORTH ABOVE AND ON THE REVERSE <br />�� <br />SIDE OF THIS DOCUMENT (FROM ABOVE) <br />❑ CHECK NUMBER <br />H <br />TODAY'S SERVICE/SALE " ' 4' PLEASE CHARGE ACCOUNT FOR THIS TRANSACTION UNLESS C <br />Jr <br />❑4" INDICATED IN THEPAYMENTRECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. F <br />PREVIOUS BALANCE AS FOLLOWS LDRMMOE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. LU <br />(FROM ABOVE) <br />INVOICE # AMOUNT$ i INVOICE # AMOLINT$ 'This Is to certify Mat the bo named materials are PrDipeny cassillied, packaged, marked and ladal.d, and am in <br />properconncM, fortrandspnetibn according to the applicableneg,lati.n.0th. Diiparnnent -Tansportation.' TOTAL DUE <br />E MANIFEST r <br />P' VIOUS <br />SEO <br />CREDITO SIM <br />— AODE 11 -AC� _�;ffiw DO NOT WRIT IL <br />CARD 0 <br />CREDIT CARD NO. EXP. Print Customer Name <br />AMEX <br />VISA S <br />= <br />MC By: <br />CUSTOMER REFERENCE L___ Customers Authorized Representative <br />INFORMATION THIP A('41QPPRAPKIT (()KITIKII I[ZQ r)KI TWC: 0M/r_DQC: QIr')I= <br />