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%_ ,v1 i — I... V1. ccCl - J.ILO , V. UuNo INIv. v0 -1v/ _o= I r1tLj. IU NLuj.. 13 It$ %.Ouo 1 %jivir–Ill <br />Columbia, South Carolina 29201 <br />FOR SERVICE CALL <br />BRANCH MANAGER Doc. Exp. SCHEDULED SCHEDULED <br />CUSTOMER NO. <br />SERVICE WEEK TERRITORY <br />C j 4 <br />R A P i T 1� <br />-T6] <br />PREVIOUS BALANCE .. <br />CODE OVER 60 DAYS <br />Q <br />1 <br />BUSINESS CHAIN OUTER SVC. P/C PROD. P/C <br />TYPE COUNTY <br />, TOCKTIJH"; AVE <br />I <br />AT TN ACC T� PAYABLE <br />LOCATION TAX EXEMPTION No. <br /><1 - <br />1 "PON' :C 9 5 Ln 6' 4 <br />7 <br />F `11,8501 <br />�VlSERVICE DATE SALES REP NO., CUSTOMER P.O. NUMBER <br />CUSTOMER PHONE # <br />HANDLING ASSOC- <br />TAX CODE CODE CODE SERVICE TAX C.O.M.S. TAX PRODUCT TAX ­ <br />"I L/ <br />j9 <br />L -KI. AL <br />LEP SERVICE/ REMARKS/ <br />DUAN. CHARGE <br />PRODUCT UNIT PRICE <br />SALES TOTAL WASTE SOLVENT/ RUMS SERVICE <br />TAX CHARGE CC 'E M wv. PROMO MSDS <br />MIN. <br />CLEAN '- I SKDOT S)(INITLAL) (yy ww) CODE <br />OONT. TERM MEI�K NO. I- GKIN <br />0,437-7 <br />EJ <br />8 9 440 <br />2 El <br />5 S F J2 4 9 1; S 4 • 600C <br />El <br />L. i- Lj <br />'2 <br />El <br />7`7 <br />. ........ <br />01 <br />TOTAL-SERVICE/PRODUCTS <br />CHECK GOOD POOR YES NO YES 00 <br />APPROPRIATE MACHINE E CONDITION DECALS IN PLACE o Ei MACHINE PROPERLY GROUNDED 0 El <br />AND LEGIBLE <br />& CLEANLINESS LOCAL PHONE NO. SPI CKER <br />FUSIBLE LINK AFFIXED TO MACHINE 11 ❑LLJ <br />El 11 <br />USEPA TRANSPORTER ID NO. USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA <br />ID NO. GENERATOR STATE <br />!D NO. LAMP ASSEMBLY INSTALLED <br />11 0 SPENT SOLVENT MEETS <br />_v, I <br />EMERGENCY CLOSING <br />CONDITION ACCFPTANCE CRITERIA 11 0 <br />OF UV UNOBSTRUCTED Ej E7J G <br />11. US DOT DESCRIPTION (INCWDiNG PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) <br />12- CONTAINERS <br />NERS <br />TYPE <br />13. TOTAL <br />QUANTITY <br />14. UNIT <br />WTIVOL <br />SK DOT NUMBER <br />I CERTIFY THAI MY TOTAL <br />WASTE STREAMS ARE WITHIN <br />THE <br />ONE OF THE FOLLOWING. <br />CATEr <br />CATEGORIES. <br />AN <br />0 TO 220 LHS./MONTH <br />z <br />INITIALS <br />220 LBr <br />< <br />INITIALS <br />1 LIJI <br />GREATER THAN 2,200',BS./MONTH <br />O <br />INITIALS <br />0CD <br />DESIGNATED F�,QJLITY NAME AND ADDRESS <br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED D <br />EITHER IN THE CHARACTERISTICS OF THE WASTE USA EPA I <br />NO. <br />0<- A <br />— 3 115 loo <br />Z > <br />'D <br />L -v <br />MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. <br />WASTE MATERIALS. <br />05 <br />Uj <br />CHARGE <br />Q <br />CASH <br />TOTAL RECEIVED <br />APPLY PAYMENT TO: <br />NO,;- <br />- W.,TjW-' <br />I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND <br />SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. <br />PLEASE I CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br />U T <br />TOTAL <br />(FROM ABOVE) <br />CHECK NUMBER <br />❑ TODAY'S SERVICE/SALE <br />WASTE MIN. <br />(FROM ABOVE) <br />M q: <br />< <br />LIJ D_ <br />❑ PREVIOUS BALANCE AS FOLLOWS <br />LDR MESSAGE <br />L i) K <br />MANIFEST CODE SEQ # <br />RECEIVED <br />INDICATED IN THE PAYMENT REC ED SECTION- THE INDIVIDUAL SIGNING THIS <br />SI <br />!CUMENT Is DULY AUTH TO GIN AND BIND CUSTOMER TO ITS TERMS. <br />AUTHORIZED <br />d' peel, and d.. <br />'p., oaMtr"' ov,e,pofaaor, "y w Uja applicable vegvlafie of ft of T-sp.,teao,.' <br />�� ';-, <br />& <br />INVOICE # AMOUNT$ INVOICE # AMOUNT $ <br />PNO <br />TOTAL DUE <br />EVIOUS <br />PREVIOUS <br />' <br />DO NOT WRITE IN THE AREA BELOW <br />CREDIT _ <br />ICARD <br />2 <br />H 211. <br />'e 11.1 - ';�' <br />D D <br />•-IN THE EVENT OF AN <br />EMERGENCY CALL <br />�Print_Custornefr Name <br />BY: <br />Ctisf6mer'S Authorized Representative <br />A <br />CREDrr <br />CARD NO. <br />AM EX EXP.DATE <br />VISA <br />MC LLM <br />CL. <br />iUSTOMER REFERENCE <br />I!J'F0Rk4A*n0f,' <br />10 (24 hours) <br />'rUIL1 A11_MI=l=AAl=krr ICO r1k. -UC <br />