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Columbia, South Carolina 29201 . <br />CUSTOMER NO. <br />TRANSPORTER 2 ID NO. <br />FOR SERVICE CALL BRANCH MANAGER <br />GENERATOR STATE ID NO. <br />ULE <br />DOC. EXP. SERVICE WEEK rE�RamoR�Y <br />a <br />14. UNIT <br />INT r <br />,- <br />_ 11 0 n GOOD POOR <br />�fOTAL-SERVICE/PROQUCTS +j' 7 1 1 R �� /' tJ u1U CHECK ❑ ❑ DECALS IN PLACE <br />7 ^7� t APPROPRIATE <br />/ BOXES MACHINE CONDITION AND LEGIBLE <br />8 CLEANLINESS FUSIBLE LINK <br />091- 45-1011 RALPH TORRES <br />NO <br />6/28/03 C3-18 02 0023324846 <br />•} <br />C l3 i_.I <br />1 R a <br />a I:. ] 7 7 <br />as 9 6 <br />wr <br />pmpaHerontf-q na,reaew—cilMaepanmem r, uaporerw • <br />NAME AND ADDRESS <br />160013 b8:TH STREET <br />SAFETY-KLEEN SYSTEMS, INC. <br />SACRAMENTO CA 95828 <br />CREDIT' <br />r PREVIOUS BALANCE <br />CODE SAL R'O-Ms— <br />S F <br />=`. <br />Print Customer Name f I <br />( J <br />By: <br />0 TO 220 LBS./MONTH <br />I <br />Customer's Authorized Representative I <br />9 1583.12 <br />S <br />T <br />BUSINESS OUTER <br />CRAW <br />TYPE COUNTY SVC. P/C PROD. P/C <br />M ' 942 S <br />STOCKT N AVE <br />C9 QCu0 NO ©L04 0001• <br />1 <br />I <br />C) <br />� Q <br />LU <br />E , A T T N <br />ACCTS PAYABLE <br />/lV.. <br />LOCATION TAX EXEMPTION NO. <br />R S? PON <br />CA 95366-2784 <br />718501 <br />SERVICE DATE <br />S E N CUSTOMER P.O. NUMBER <br />CUSTOMER PHONE # <br />TAX CODE HANDLING <br />CODE <br />ASSOC. SERVICE TAX C.O.M.S. TAX PRODUCT TAX . <br />CODE <br />019-599 -4?4', <br />05-1.95-7:2 n q <br />• R <br />...0775 .C7 <br />SERVICE/ <br />SEPT <br />•s REMARKS/ <br />QUAN. <br />CHARGE <br />SALES TOTAL <br />WASTE SOLVENT/DRUMS <br />CC <br />SERVICE CHANGE CHANGE .RIV PROMO ( MSD: <br />RVICE CATE <br />Sh <br />PRODUCT <br />NUMBER UNIT PRICE <br />TAX CHARGE <br />MIN. CLEAN SPENT �. SK DOT <br />CODE <br />TERM ME WIN) CODE NO. GIVE <br />11LOS7000 <br />07715129 1 <br />198.25 <br />15.36 213.61 <br />0.0a x XX 1 12800 <br />4 <br />— --- <br />2 0 000CJ1 <br />1 <br />5.90 <br />0.00 5190 <br />0.0� X XX <br />W TE MATEOIRALS THE PROCESS GENERATING THE <br />0 <br />, - r <br />_ _ <br />C r`Z f [� YC�,/if <br />7 <br />7- <br />e �+I a { 1 <br />�j iii+� i^ •% `i r.. - [ • 7 1t , ; lT = <br />S <br />'- <br />4 <br />3 <br />9 <br />10 <br />1i <br />12 <br />AffD�D <br />TRANSPORTER 2 ID NO. <br />GENERATOR USEPA ID NO. <br />GENERATOR STATE ID NO. <br />�Tx=CC"rte 933 <br />14. UNIT <br />INT r <br />,- <br />_ 11 0 n GOOD POOR <br />�fOTAL-SERVICE/PROQUCTS +j' 7 1 1 R �� /' tJ u1U CHECK ❑ ❑ DECALS IN PLACE <br />7 ^7� t APPROPRIATE <br />/ BOXES MACHINE CONDITION AND LEGIBLE <br />8 CLEANLINESS FUSIBLE LINK <br />YES <br />NO <br />YES <br />MACHINE PROPERLY GROUNDED <br />LOCAL PHONE NO : itCI:ER <br />i' MA'TIINE <br />NO <br />h; S <br />U <br />y <br />-� <br />USEPA TRANSPORTER 1 ID NO.USEPA <br />TRANSPORTER 2 ID NO. <br />GENERATOR USEPA ID NO. <br />GENERATOR STATE ID NO. <br />�Tx=CC"rte 933 <br />14. UNIT <br />INT r <br />CAD0091-19314 <br />C <br />5 <br />11 i. US CTT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) <br />LL, <br />Rjf A 1 <br />I <br />C <br />..7 <br />I CERnI--Y THAT MY IOTA <br />WASTE STREAMS ARE WITH!. <br />ONE OF THE FOLLOWING <br />CATEGORIES. _ <br />y <br />-� <br />�DESIGNATEDFACIUTY <br />wr <br />pmpaHerontf-q na,reaew—cilMaepanmem r, uaporerw • <br />NAME AND ADDRESS <br />160013 b8:TH STREET <br />SAFETY-KLEEN SYSTEMS, INC. <br />SACRAMENTO CA 95828 <br />CASH i_J 1 TOTAL RECEIVED APPLY PAYMENT TO: MANIFEST NO. <br />CHECK NUMBER El TODAYS SERVICE/SALE U 5-3 <br />I �PREVIOUS BALANCE ASFOLLOWS LDR MESSAGE <br />PPIREVIIUS4 f iJOICE # j PMOUNT$INVOiCF #. AMOi ff $LDR REQ'D <br />MANIFF_STCODE SEQ # <br />CUSTOMER REFERENCE <br />INFORMATION <br />LAMP ASSEMBLY INSTALLED - ❑ 1__I J L -j u <br />SPENT SOLVENT MEETS <br />EMERGENCY UNOBSTRUCTED <br />GONOI110N OF UD UNOBSTflUC7E0 ACCEPTANCE CH'0 <br />TE 0 Eli <br />f <br />I <br />12. COtTTAINERS <br />O. <br />w .�. <br />>I - <br />R <br />13. TOTAL <br />TY <br />14. UNIT <br />INT r <br />SK DOT NUMBER - <br />C <br />5 <br />1 ( <br />ry <br />ti <br />C <br />..7 <br />I CERnI--Y THAT MY IOTA <br />WASTE STREAMS ARE WITH!. <br />ONE OF THE FOLLOWING <br />CATEGORIES. _ <br />y <br />-� <br />wr <br />pmpaHerontf-q na,reaew—cilMaepanmem r, uaporerw • <br />TOTAL DUE -� <br />Ict �U e k— rn/ <br />DO WRITE IN THE AREA BELOW <br />t ! <br />NOT <br />I <br />002:3.324- 4L <br />Print Customer Name f I <br />( J <br />By: <br />0 TO 220 LBS./MONTH <br />I <br />Customer's Authorized Representative I <br />0 <br />_ <br />INITIALS <br />220 LBS tas,�L <br />I� <br />I <br />C) <br />� Q <br />LU <br />/lV.. <br />I Q <br />c <br />GREATER THAN 2,200 LBS!MOMiN <br />INITIALS <br />1i C <br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED <br />EITHER IN THE CHARACTERISTICS OF THE WASTE <br />USA EPA ID NO. C A 1] Q <br />C) ,i 8 4 817 <br />Z <br /><C! <br />STATE ID NO. C A 0 0 0 0 <br />C 8 4 -L 1 ? <br />W TE MATEOIRALS THE PROCESS GENERATING THE <br />Lu," <br />I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND <br />CONDITIONS SET FORTH ABOVE, AND ON THE REVERSE SIDE OF THIS DOCUMENT. <br />PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br />TOTAL CHARGE <br />(FROM ABOVE) <br />% � _ /, / <br />J / <br />w .�. <br />>I - <br />R <br />INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS <br />WASTE MIN. <br />- La.' <br />DOCUMENT IS DULY ALmiORIZED TO SIGN AND RIND CUSTOMER TO ITS TERMS. <br />(FROM ABOVE) <br />LU <br />^his Is w ce fy If W tae IJCHe nemeo materiels ere property package. m,rked a waelea.:.rtl are u• <br />wr <br />pmpaHerontf-q na,reaew—cilMaepanmem r, uaporerw • <br />TOTAL DUE -� <br />Ict �U e k— rn/ <br />DO WRITE IN THE AREA BELOW <br />t ! <br />NOT <br />I <br />002:3.324- 4L <br />Print Customer Name f I <br />( J <br />By: <br />--A <br />Customer's Authorized Representative I <br />THI.4 ArPFFMFNT r0NTINl IFS nN THF RFVFRSF SIDE <br />