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1301 Gervais Street-Suite 300 DUNS NO. 05-397-6551 FED.ID NO. 396090019 UUP I UNILH Columbia,South Carolina 29207 S \` 7j FOR SERVICE CALL BRANCH MANAGER DOC.EXP. scHEDULEo SCHEDULED amillm�. CUSTOMER NO. �-i-! ❑ 1 1 iJ '\�p['r SERVICE WEEK TERRITORY •: • LU 7•'°��l�'.�:LiL11 HLE�II T ORRE,? L.L/.liJ/J..1 .J.S"�� L-1 JJ 4..su779f� n r CREDIT PREVIOUS BALANCE C v J U `•1 LJ 4 u `1 "1 J CODE AL. Y S C v A" W V, ►-t C 17 J 9.9'u 11. 1:. 4.3 T BUSINESS TYSCHAIN COUTNR SVC .P/C PROD.P/C ° �-_Mt� i HANLAN �D s� 79.b ;,,0 G�-11 '-1_? E i=n L N C H C A I•i - CA y L"9 b❑u LOCATION TAX EXEMPTION NO. R ,51� HANDLING ASSOC. RV DPaTE S S R NQ. C NUMBER CUSTOMER PHONE# TAX CODE CODE CODE SERVICE TAX C.O.M.S.TAX PRODUCT TAX J �u9-963-697u 775 SERVICE/ L i�1 riL REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANCE L t wv. PROMO MSDS DEPT PRODUCT t.' N^a ti UNIT PRICE DUAN. CHARGE TAX CHARGE MIN. CLEAN SPENT "� CC TERM SERVICE TERM s le CODE NO, GIVEN N U 113 L'1� caNT $K DOT (WEEKS)(INITIAL) 1 :ju iG�3lJ } XX Xx U ❑ (Lj_ 13.19 37 1 27L.v L 1. 0 8 C 3* . .J a LJ. L,LJXX XA 11260 El 3 ii717 7 u6' j y_2• GLJ6 1 L 12674 C ❑ J4 i; Ji!3�i1 i ? y j. `1u J.JJ 5. 9� u. u`1XX X J ❑ 5 ❑ 6 El 7 ❑ 8 ❑ 9 ❑ 10 ❑ 11 ❑ 12 ❑ �,' "+C CHECK GO POOR ES NO S NO ( APPROPRIATE DECALS IN PLACE ❑ MACHINE PROPERLY GROUNDED ❑ TOTAL SERVICE/PRODUCTS � � 7�( �, BOXES MACHINE CONDITION ❑ AND LEGIBLE LOC AL PHONE NO STICKER Z 6 CLEANLINESS FUSIBLE LINK INSTALLED ❑ AFFLYED TO MACHINE ❑ W USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID O, GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLYEMERGE EMERGENCY CLOSING SPENT SOLVENT MEETS CONDITION ❑ ❑ ACCEPTANCE CRITERIA ElT A R u V u:U_!I✓�,L) L A L iJ u u y L3 Jr a OF LID UNOBSTRUCTED 12.CONTAINERS T3. TOTAL t4.UNIT I CERTIFY THAT MV TO7A 71.US OOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID. SK DOT NUMBER y 1 W ` ry�pq� •y p / ''--}�/•-�� N TYPEAN ITY WASTE STREAMS ARE WITHI 1ASTL PAIN �L ` �E.Jj--.LI�TL�i1ML �I�' ill C1?ll-�Rr (Dp61,yJL8) �� yL0 4 ONE OF THE FOLLOWING CAl EGORI 118) 7. c /6AL (FJDL,FJu3� D635,DCa36, DJ38,DJ39, DO4u) 070J'&NTH p TE PATIVT RELATED MATERIAL, ' LiN1L63 Pi, I1 (LR6 1,28) / d{• '? 1/) P jj U 3. 7 .� /GAL (tL1L'J,FUuT,✓JL' L.DJ3�8;DiJ35,DJ3s, Di:39,Ju4J) ( +� 220LES.T02,200LBS/MONTH INITIALS W GREATER THAN 2.200 LOS./MONTH J INITIALS 0 O ` I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED DESIGNATED FACILITY NAME AND ADDRESS ,A F GL T Y-K L/E�.L'w S Y S T L i+'i J, I Pr CC. EITHER IN THE CHARACTERISTICS OF THE WASTE USA EPA ID NO. ti A u J,.�t.J 8 i 5 L 7 a Q L4 L/J L/ i)..+T H ST N L�.. 1 SACRA 1`)L iY T V CA 958.�y� MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. C A U.3 G V J 6 4 LU�D WASTE MATERIALS. CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: MANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE i CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT (FROM ABOVE) 5;F-- CHECK NUMBER ❑TODAY'S SERVICE/SALE PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE CC Q INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. W a .. [—]PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) N • m,a a to ae,aty u,v the eowe� w o,etww,we P,,pWy"•�M' I.waaaed,e,e,aed Wd labeled.ehd 11,1 • INVOICE# AMOUNT$ INVOICE# AMOUNT$ t L il IC f�E� � ProPercandlbmbrrcarevodalan Wrglathe app'��.,egoleeonaolmaoaPvunwnol7ranwodalnn• TOTAL DUE PREVIOUS. MANIFEST CODE SEO# _ DO NOT WRITE IN THE AREA BELOW CREDIT CA 19 , 1 111 c ��JJJ CARD N -print Custom r ams AMEX \ uuc 4.-,%779:: VISA IN THE EVE14T OF AN ) UV09°"u4L 9-9J "°U MC By: EMERGENCY CALL Customs orized Represeri alive CUSTOMER REFERENCE 1-800-468-1760 rule Ar-DCCAACNIT rnKITInII IFC nKI TNF RF\/FRCF.qN1F