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Columbia, South Carolina 29201 S' � klePH. CUSTOMER NO. ( i'. _'i -,'-Q J T - 42 S TOCKTON AVE E ATTN ACCTS PAYABLE " ' FUPON CA 95366-2?f-k4 1 11111111131 CE DATE SERVICE] PRODUCT CUSTOMER P O. NUMBER LAS r, 8 REMARKS/ DUAN. CHARGE UNIT PRICE 3S --&4t.?nQLU' 148.0000 - - 9 '-'--2-? 0 0 c 0 _i LY 649.0 0 t� i TOTAL-SERVICE/PRODUCTS FOR SERVICE CALL BRANCH MANAGER 19-545-1011 RALPH TORRES ;I T L.O L tI CUSTOMER PHONE # -09-599� SALES I TOTAL TAX CHARGE DOC. EXP. &-;HEDULED SCHEDULE[ SERVICE WEEK TERRITORY 06/28/03 03-18 04 GODE PREVIOUS BALANCE 8 L583.12 BUSINESS OUTL CHAIN I OUM..Y SVC. P/C i PROD. P/C ---t 00233542`7 ' CHECK GOOD POOH YES NO YES NO -I APPROPRIATE MACHINE CONDITION ❑ ❑ DECALS AND EGIBEE ❑ ❑ LOCALMACHPHONOE NO. STICKER TOED ❑. ❑ -; z BOXES $ CLEANLINESS FUSIBLE LINKII 'l USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID NO. � 09 10000 1 N0 1079?000- 1 1 ICAD009119314 LOCATION TAX EXEMPTION NO. � 7185[?• I HANP TAX CODE LINODE V _ SERVICE TAX C.O.M.S. TAX PRODUC- TAX ._. ODI_ I 05.195-7`20 h, ? 777 , DESIGNATED FACILITY NAME. AND ADDRE.SS rMtered By WASTE SOLVENT/DRUMS SERVICE CC CHANGE 1 'WGE I ylV, PROMO ..=TERM VM- DATE '"SCSI 1 ,3 MIN. c SPENT �a SK DOT corvr. TERM EEKS)(INIRALI YY WIN) CODE NO. (W- ( 4 � j {; uNfti -�LEa` �.. - j n 9f -a % 0 1 CHECK GOOD POOH YES NO YES NO -I APPROPRIATE MACHINE CONDITION ❑ ❑ DECALS AND EGIBEE ❑ ❑ LOCALMACHPHONOE NO. STICKER TOED ❑. ❑ -; z BOXES $ CLEANLINESS FUSIBLE LINKII 'l USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NG. I TXR000050930 ICAD009119314 11. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD — Reee P.O. No. r----- Line No. ._. Receipt Doc.�� DESIGNATED FACILITY NAME. AND ADDRE.SS rMtered By CASH LI I TOTAL RECEIVED I APPLY PAYMENT TO: (HECK NUtiffiER-- I ❑ TODAYS SERVICEISALE ❑ PREVIOUS BALANCE AS FOL'_OINS INVOICE # AMOUNT E INVOICE # AMOUNT $ CREDIT ,-,a � I AMEX I TI VISA _ 111 rrc CUSTOMER REFERENCE INFORMATroN INSTALLED ❑ ❑ AFFIXED TO MACHR.E CI LJ I € LAMP ASSEMBLY CONDITION ❑ ❑ FI--'-++ II EMERGENCY CLOSING ❑ ❑ SPENT SOLVENT MEETS ACCEPTANCE LWERW L— ❑ I rte. OF UD UNOBSTRUCTED 12. CONTAINERS 13. TOTAL 14. UNIT r l ` I CERTIFY THAT MYTCTAI! NO.WT/VOL SK DOT NUMBER 0' L, _ Q WASTE STREAMS :,RE ONE OF THE FOLLOWING CATEGORIES. 0 TO 220 LBSJMONTY I (� IZ I INITIALS 220 LBS. r 2,200 LBSJAIL INI 1 LU _ GREATER THAN _ LBS/MONTH --� I IV / L^. _INITIALS �= I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA. EPA. !D NO. EITHER IN THE CHARAG- ERISTICS OF THE WASTE MATERIALS OP. IN THE PROCESS GENERATING THE -T-L I I WASTE MATERIALS. STA, E ID NO. W 47 MANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE 1 � � 0_ — CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) r /•� PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE---� [` —T INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. T i7 CDR i NOT MESSAGE �f A DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM. ABCVE)-This is Z D f'. 1 Y V t : ` L lX y P� m —fify :hv � a -name. �ws a� poxM ea. pac yged, m *r J wd I wee, wd are n. eo�vone,�, uRRae d, leu,., eve, u�Reelue� ellen: �IMR TOTAL DUE Cf Cl MANIFEST CODE SEG # �, r DO NOT WRITE IN THE AREA BELOW Print Customer Name CEO, 7 IN T . HE EVENT OF AN 0023354291 REMERGENCY CALLY` Customers Authorized Representetive ME F THI.q AC.RFFMFNT rf1NTINl IFti TIN THF RFVFRPF fi1nF