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��ivaraa.xianr- Aeaw <br />Columb ouch Carolina 23201° <br />_( ' <br />OUNSNO.05397$551 FED. ID NO. 396MOOl9 Li4IVMt#1 <br />FOR SERVICE C BRANCH MANAGER <br />DOC. EXP. <br />NG <br />CASH <br />. <br />MFR PA <br />APFLY PAYMENT TO. <br />CHECK NUMBER <br />LOCAL MNIE NJ. SFA M <br />SECRVICEAM EEK <br />rm:VOSCHEDULEDRY jjjjjjjjjjjj� <br />El <br />❑ PREIMUS&WwCEA6WOWS <br />INNOiCEA <br />AMOUNTS <br />INN]lCEIt AMDIJNT$ <br />Cl❑ El ❑ <br />- - - - — ; - <br />---- - -- <br />- - -- <br />E5 <br />� <br />1'2. C <br />AINEAS <br />EXPIRED_ <br />14, LNIT <br />SK DOT NLYAT3ER <br />CREINF CARD NO: <br />07.9033099 <br />Imo. GATE <br />J 07AL <br />is I <br />4 0 <br />7 — <br />9 <br />9 <br />7 <br />1 4 <br />�; PREVIOUS BALANCE <br />U0 <br />ONE OF TIS FCWViW <br />S <br />TTRIC <br />is T UK CHEVRON #1549 <br />Nis CIN <br />u COUNTY <br />SVC. P(c PROD. Pr- <br />o <br />905 W. BENJAMIN HOLT <br />CAT <br />E <br />TOC KTON CA 95207 <br />LOCATION TAX EXEMPTION NO. <br />A <br />a T40 = L8S.7h omm <br />'7 ARQI <br />SERVICE DATE ISALEES KP W. CUSTOMER P.O. NUMBER <br />CUSTOMER PHONE TAX CODE H4NDUNG <br />OODE <br />CODE SERVICETAX C.O.M_S_ TAX PRODUCTTAX <br />CODE <br />SERVICFI s ' R� / mum <br />DUAN. CHARGE <br />SALES TOTAL WASTE SOLVENT/DRUMS <br />CG SERVICE CI++w+rf J2Uh7F INA p Wisps <br />I <br />TAX CHARGE MIN. RENT _4,A+IT. SK DOT <br />TERAi SERVI �EAtI MAW GY41 N <br />, , �„ ly ; � aOE No. y T F n i Zan <br />4 <br />7 <br />B <br />9 <br />10 <br />11 <br />12 <br />TOTAL-SERVICEIP RODUCTS <br />11. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND <br />I MANIFEST CODE I SEQ # I <br />r <br />OOa1 POOR YDS <br />NG <br />CASH <br />TOTAL RECEIVED <br />APFLY PAYMENT TO. <br />CHECK NUMBER <br />LOCAL MNIE NJ. SFA M <br />®TOTt415SEWu9CF1SALE <br />El <br />❑ PREIMUS&WwCEA6WOWS <br />INNOiCEA <br />AMOUNTS <br />INN]lCEIt AMDIJNT$ <br />Cl❑ El ❑ <br />- - - - — ; - <br />---- - -- <br />- - -- <br />E5 <br />� <br />1'2. C <br />AINEAS <br />EXPIRED_ <br />14, LNIT <br />SK DOT NLYAT3ER <br />CREINF CARD NO: <br />Imo. GATE <br />I MANIFEST CODE I SEQ # I <br />-—EM THE AREA BELOW - <br />P6M Customer Name f <br />007.9033099 <br />ex4„'°—;�'-��— 0001-9977-14 —5 <br />OOa1 POOR YDS <br />NG <br />CEOAJSINPLAORu LEGIBU: <br />BPPAOFMIE <br />111i ❑ ❑ ❑ <br />WE��LYGU NDER �I��y <br />❑ ❑ <br />CLEMIL LESS R. � LINK <br />LOCAL MNIE NJ. SFA M <br />Z <br />El <br />11 AUMMAIACM 11 ❑ <br />W <br />IAMPASSEYBIY ❑ CLOSPF3 <br />CCtARIC9i El FA <br />E] <br />Cl❑ El ❑ <br />Q <br />CFUD WIMSENUCfm <br />ACCEPTANCE <br />1'2. C <br />AINEAS <br />13. TOTAL <br />14, LNIT <br />SK DOT NLYAT3ER <br />J 07AL <br />is I <br />WASTE STREAMS ARE IMTl4AJ <br />i <br />ONE OF TIS FCWViW <br />CAT <br />a T40 = L8S.7h omm <br />711TTfla <br />I <br />V <br />227 LW_ TO 2?7tq L8SX.IONiH <br />INITIALS <br />WATER THAN Smo UBSJNONTN <br />I CERTIFY TI -IAT ND MUBUL CHANGE HAS OXWKEDUSA <br />ERHER E ihRACTEA <br />IN VO15T= OF THE Y.r,. <br />EPA <br />W NO. <br />Q <br />VMS TEHVLS THE PROL£.'S.4 GENB•IAThYa THE <br />STATE ID NO. <br />I AGREE TO PAY THE ABOVE GRARC;ES AW TO BE EI MIND BY THE TMW AND <br />TOTA.LCHARGE <br />OCNDmDNS SET FGMH AWYE AND ON THE FEVERSE SIDE OF THIS OOCUMEN€. <br />(FROM ABOVE) <br />> F <br />PLEASE OWIGE MY AOC.CXINT FOR THIS TRANSACTION LN DBS OTHERNISE <br />INEICATED IN TT -E PAYMENT RECEIVEO EECTICf1. THE KWOUAL SrwNa THS <br />WASTEMSI. <br />DOCUABiTIS OLILY AUHOMEED TO SONAND DING WS"AER TO ITS TEAMS. <br />(FROM ABOVE) <br />�a <br />'Iht'e bCa&r t3etiAw �.nAaarnW itllvAua ae oAogt- da®aKLL ..qwU s'�0 LGye4 ii+0 w n <br />TOTAL DUE <br />-—EM THE AREA BELOW - <br />P6M Customer Name f <br />007.9033099 <br />ex4„'°—;�'-��— 0001-9977-14 —5 <br />