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WE Columbia, South Carolina 29201+ IIHtoleeN. CUSTOMER NO. "'= �' FOR SERVICE CALL BRANCH MANAGER DOC. EXP. SCHEDULED SCHEDULED SERVICE WEEK TERRITORY 0ww!)6 04 3n227U — 2C9«'5PH TORRCS 04lQ.S Q3 u 0 7 7 IMP9 I CO PREVIOUS BALANCE � BALDER 60 DXY'S BUSINESS I r/PE OUTER CHAIN COUNTY SVC. P/C FROG. Pig' r ryC NO --= 0791. �f 0i 942 S r1'OCf''TLI AVE^`? LOCATION TAX EXEMP rON NO. A T T N A C C T c PAYABLE• ?11t5n1 TPON C 9i' , e-2?84 SERVICE DATE SALES REP N0. ( CUSTOMER P.O. NUMBER -- HANDLING ASSOC. CUSTOMER PHONE # TAX CODE �pE CODE SERVICE TAX C.O.M.S. TAX PRODUCT TAX -79..599-424?, Q5�195-?2C9 "I`1 775 I .+ _ _ .^��'- SERVICE/ = REMARKS/ DEPT QUAN. CHARGE SAES TOTAL WASTE SOLVENT/DRUMS ' SERVICE CHANGE CHANGE INV. PROMC -10S scKoa,E CC SERKS)(IN PRODUCT 1 M(9 E IR UNIT PRICE I j �, TAX CHARGE MIN. CLEAN sPlS �� SK DOT TEAM (WEEKS)(INITIAL) m vn0 c00E NO. 4 E.L �' A S �' HiQ s "6:`JEh A ^ 0 88,88P- 0020413 5 U48.003 2 11 U_B,8888 00271495 1483 ©90 _ _ I 2 �_ 0 00U88 8 0106S99 327,0000 2 [Q_ —— ------ 'n, 1888880205734 649,900 ---n i'� liTo — TOTAL-SERVICE/PRODUCTS _ POOR YES NO YES NO UG DECALSL GLACE MACHINE PROPERLY GROUNDED j— ^�" APPROPRIATE MACHINE CONDITION AND LEGIBLE CHECK G1jD F �,� BOXES g CLEANLINESS EMERGE LINK LOCAL PHONE N0. nt iCKER 11-'��1 AFFIXED TO MACHINE --► INSTALLiO IJ �+ GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASS FMaeLY SPENT C,IIND;TiON G OFEMERGENCY CLOSING �'j T ❑ "r OF LID W!OBBTRUCTEO �-J ACCEPTANCE CflITEAl.4 (j 1 USEPA TRANSPORTER 1 ID UO. USEPA TRANSPORTER 2 I NO. `1 �" ; t- - 'MY f' 1 f 11. U. DOT DE` RIPTION (INCL D;f3G PROPER SHIPPING NAME, HAZARD CLASS, AND ID. tz CONTAINERS 73. TOTAL QUANTITY_11�tYPE 74. UNIT SK DOT NUMBER 1 30 $ 1 CERTIFY THAT TCTr WASTE STREAMS ARE IVITHI J C VED VV L.l TZ RECEIRECEIVED RIPON — ONE OF THE FOLL(iWbN CATEGORIES. 0 TO 220 LBS./MONTH 0 I — 'j ��yy Q ¢ receipt ate '�-' /' .fes/�`�" 1� I _ INITIALS C/ fes•'''' 220 ' int t1 i r.. _ . e. p �_ I cn A n'p'e Line I e i �d o w JF-- ,- GREATER THAN 2.200 L3S./MOwTH Receipt DOACe..,(� INITIALS 0Q FACILITY �NAB9FIESS �T— I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID EITHER IN THE CHARACTERISTICS OF THE WASTE NO. 4 CASH ❑ TOTAL.RECEIVED APPLY PAYMENT TO: MATERIALS OR IN THE PROCESS GENERATING THE STATE ID N0. WASTE MATERIALS. iJAMfFESTN0. I AGREE To PAY THE ABOVE cHARGes AND To 6E BOUND BY THE TERMS AND W M I _ TOTAL CHARGE �— ODESGNATED CHECK NUMBER TODAYS SERVICE)SALE CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (��. PLEASE CHARGE MY ACCOUNT FOR 'THIS TRANSACTION UNLESS OTh....:S. (FROM ABOVE)r- �. `r E] PREVIOUS BALANCE AS FOIICWS INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS LDR MESSAGE OQCUMFNT IS DULY AUTHORIZED TO SIGN .AND BIND CUSTOMER TO nS TERMS. WASTE MIN. (PROM ABOVE) o. U) INVOICE # AMOUNT -i INVOICE # ` AMOUN f $ - 5 - / T T" a `° `°" y ^� e . woce�r ��.a >ae. m. k.a . n nom• . aro a p p NOT- L D R N O i R = 11� L' a�ox w�aluoT uo,,,��y - vA nie �eewemre oI me D.2. -- 01 r,.nsvenanc� • e r _ TOTAL DUE —� MANIFEST CODE SEQ# DO NOT WRITE IN THE AREA BELOW I CARD NO_ "Z L' Prin C tD 1 N e� ✓� i gyi� C s Auth riz presentative 400-4684760 (24 THIR Af',RFFMFNT C;ONTINl1FS ON THF RFVFRRE RIDE r; 'O 1 7 q ro LCL. 7'�i -: M lj�7rtn CREOrr CARD NO. AMEX EXP. VISA �j��,� MC W_1J.. DATE iI ( �� I -- j ! CUSTOMER REFERENCE �� iNrORM1.ATiON I t