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1301 Gervais Street-Suite 300 �� DUNS N0. 05 397-6551 FED ID N0 396090019 CUSTGPiiE=R Columbia,South Carolina 29201 WE CAMS - ti � SCHEDULED SCHEDULED FOR SERVICE CALL BRANCH MANAGER DOC.EXP. B IIBI. �..a.� SERVICE WEEK TERRITORY CUSTOMER NO. 9•-545-1011 RALPH TORRESL-1 10a 03-'39 25 O0 '441 ? 199 CRED u .• �� v i CODE PREVIOUS BALANCE A .OVER 3L• s IN C 1182, 96 5`14 a 4 71 BUSINESS OUTER T TYPE CHAIN COUNTY SVC.P/C PROD.P/C D 10- 99b S HAKLAN KLI 2 1 u791 N0 10515 L R E Iq C H C A M P C A `15 2_11+"9 6 L u • LOCATION TAX EXEMPTION NO. IA511 SERVICE DATE I SALES REP N0. C CODE MBER CUSTOMER PHONE# TAX CODE HANDLING AssocCODE. SERVICE TAX C.O.M.S.TAX I PRODUCT TAX 2C; .1,R- "u9-983-697u 0_I-195-3123 p . x77.5 .7775 SERVICE/ `" REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE CFAIWA INV, PROMO MSDS DEPT PRODUCT I L/f� L k UNIT PRICE DUAN. CHARGE TAX CHARGE MIN. --T—NT C'C' TERM SERVICETERM uHOATF CODE NO. r 'h GIVEN ry &D" SK DOT (WEEKS)(INITIAL) YY WIYI !�E L E A a E N V • 10394830 94 0113".576 1 66 a _ 7 r 1J 7y. b5 0. Ju 1 941 4 ❑ 26294630 94.71431.3 1 iiia r 5115 71. 65 0 1 94 ' 4 ❑ 30U9463J `14 L;e,4 ]lL' 71 t+tt . SD 5. 15 7116'1 l.• : 1 `�L11 Ii ❑ 40 031L .J I 5.90 01010 5 1 9 D 0 1 0 21 ❑ 5 ❑ 6 ❑ 7 ❑ 8 ❑ 9 ❑ 0 ❑ 1 ❑ 2 ❑ C .. CHECK GOOD POOR YES NO YES NO C G`S ■4 1.: 15. 4 'S' 223, 651 'u• U^ DECALS IN PLACE MACHINE PROPERLY GROUNDED ll— TOTAL-SERVICE/PRODUCTS APPROPRIATE MACHINE CONDITION ❑ AND LEGIBLE ❑ ❑ BOXES g CLEANLINESS FUSIBLE LINK LOCAL PHONE NO.STICKER Z ❑ AFFIXED TO MACHINE ❑ (jJl USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLY ❑ EMERGEINSTN YCLOSING SPENT SOLVENT MEETS ']' ,/ ((�,(f'� tt Li i -. CONDITION OF UO UNOBSTRUCTED ❑ ACCEPTANCE CRITERVI ❑ (C 1 !\R 0ULl SJ.}S�1-.J C AL Li L:"11 6.�LU.✓ Q 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING ME,HAZARD CLASS,AND ID.) 12.CONTAINERS 13. TOTAL t4.UNIT SK DOT NUMBER '- _? _ I CERTIFY THAT My Tor LU N E QUANTITYVOL WASTE STREAMS A E WITHIN J USED CLEANING COMPOUNDS, N10 I18,Ns LIQUID (NOT USDOT O 941, CATEGORI "°""" AC 7 . USEPA REGULATED) AQUEOUS PARTS WASHER SOLUTION (£�.3 GAL) �� t- ' DTG220 /. z INITIALS �C 220 LBS.TO 2,200 LBS./MONTH a INITIALS W GREATER THAN 2,200 LBS./MONTH J UJLo INITIALS c O DESIGNATED FACILITY NAME AND ADDRESS SAFETY-F LEEN SYSTEMS, INC. IITHERYTHTHE CHARACTERISTICS F THE WASTE SA EPA ID NO. CAT7GU� 1'9h8 Z a �t'�y CC BLVD l / 95368 � p EITHER IN THE CHARACTERISTICS OF THE WASTE 7 Q 6 0 3 J S A L I D A B L V D SAL I D A C Q 1 rj 3 6 8 MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. C A T• L)7 6 L 3 9 6 8 W co WASTE MATERIALS. CD 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 -• ' V CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) - E_ >CHECK NUMBER ❑ PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE _ TODAY'S SERVICE/SALE � INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. W a E]PREVIOUS BALANCE AS FOLLOWS LDR MES\ AGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) N • INVOICE# AMOUNT$ INVOICE a} AMOUNT$ L ': T, T E D 'n1S9O°an'q mal ma aewre-°a°,m maie�� °perly owas,nae.I.aaaaaa,marwea ane Ial+ele0,r3"aro m r p,oP n� 1 v a°nau°n auo eag l K uuoons of the enl of Tran wn TOTAL DUE r, PREDOU; MANIFEST CODE SEO# I � Jt� Tarr DO NOT WRITE IN T E V CREDIT - v A� `t CARD NO~ C A H 142 Print Customer Name y CREDIT CARD NO. AMEX EXP.DATE J 2 4 4 VISA IN THE EVENT OF By: Pd^�✓ ) ^c y CUSTOMER REFERENCE CustomeYs Authorized Representative ,w,ri.n n. ��w� 1,1 .. 1 1• - TI„�+ w/�nrr��r\IT/+/1a1T11.111CC/1111 TUC[]C\/C[]CC CIf1C