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Columbia, South Carolina 29201 2 ?� FOR SERVICE CALL BRANCH MANAGER DOC. EXP. SCHEDULED SCHEDULED SERVICE WEEK TERRITORY e(tri•91s?B. CUSTOMER NO. 03-22 04 00-23557787 — 09-545-1011 RALPH TORRES 7/26/03 > 3 7 7_. ( CEDE PREVIOUS BALANCE HAL 6—OD—A79-- b DA79 — 8 25G,6.60 X1 PAPEK CQ BUSINESS TYPE CHAIN OUTER COUNTY SVC. P/C PROD. P/C C9 1- S STOCKTON, AVE ATTN ACCTS PAYABLE LOCATION TAX EXEMPTION NO. IP4N CA 953662784 718501, --- - _ S�RVICE DATE SF}VE 0 CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE H CODE G ' o E SERVICE TAX C.O.M.S. TAX PRODUCT TAX 209ga 599-424': 05®17<_??I SERVICE/ REMARKS/ DE SALES TOTAL I WASTE SOLVENT/DRUMS ounra. CHARGE CC SERVICE CHANGE CHQITf INV PROMO SERVICE TERM aCflDAE PASDS PRODUCT UNIT PRICE TAX CHARGE MIN. .oF CLEAN SPENT cotJr SK DOT TERM (WEEKS)(INITIAL) IYa xm7 CODE NO. RELEASE L E A 5 F lit O . GIVEN n,088888 00204135 848,0000 2 ! �_ ❑ 0088-888 00271495 148 0000 2 00188888 01065995 32? 0000 i _ - r ❑ 0088688 02015734 649.0000 FIn ri15 0 — ---3- i 1-31 E 3v< 0& 5757 4) I Li FtOTIAL-SERVICE/PRODUCTS ^� • / 7�GV /s CHECK GOOD POOR YES NO YES. NO APPROPRIATE DECALS IN PLACE MACHINE PROPERLY BROUNDEC MACHINE CONDITION ANDLEG19 ❑ ❑ ❑ iJ! BOXES ❑ ❑ LUCALPHONE NO.':1^KER :: J 8 CLEANLINESS FUSIBLE UNK - I - AFf1JCE0 i0 RiACHINE. in � INSTALLED ❑ ❑ USEPApTRAf�N{S'�PORTERR 1 NO: USEPA TRANSPORTER 2 ID NO. GENERA�TsOR7USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLY ME CONDITION ❑ ❑ EMERrUNOBSTRUCTED ❑. ❑ UTERUENCY CLOSING S ❑ ❑ '; T i\ U tJ :1 f "i % C A D O U 9 1 1 9 3 L 4 OF LID ACCCEPTANCVE t 11. U5 DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) 12. CONTAINERS TYPE 73. TOTAL 14. UNIT WTV L SK DOT NUMBEF� .5 { 6 T- •� 0 � 5 I CERTIFY THAT bT" TC pi WASTE TRAMS ARE WIT::,!j I'? ONE FOLI.OWIN CATEGORIES. �(,f�) 1 I 0 TO 220 LBS./MO�n �—� 6 �j �� n ht t-% ` 220 LBS, TTOL INmALs � Line No, GREATER THAN 2,200 LBSIMGNTH Fleceipt DOC. _ IN! TALS t (1 F C C �ES?GNATED FACILITY N .M_ AND ADDf3E _ } �-j — �� Entered V�\/ I 1 I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID NO. v V EITHER IN THE CHARACTERISTICS OF THE WASTE Q I L ,] THE PROCESS GENERATING THE STATE ID NO. LU WASTE MATERIALS. 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 7 M CHECK NUMBER ❑ TODAY'S SERVICEMALE - - CONDTFIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) 5: PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHER-- L' Q ❑ PREVIOUS BALANCE AS FOLLOWS 1 INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. , W TO SIGN AND BIND CUSTOMER TO ITS TERMS. s LDR MESSAGE DOCUMENT IS DULY AUTHORIZED (FROM ABOVE) INVOICE# I AMOUNT$ I INVOICE# j AMOUNT$ LDR NO REO'D — T - ' Ia k a —ty veal me aowe--d .n—ws aro p,opady d—if m, paoa,3 d. maned and Weals^, sod a.a m �.. p�g��ro.sa.�apoaroao--oiNoloaaopraoW.3wat—o, mauepan—ts.T!npona0m' j� TOTAL DUE . vo GRED!-: SEu r (� — DO NOT WRITE IN THE AREA BELOW CARD NQ I j Pant Customer Name l , CREDIT R r I 1 �— I i AME EXP. DA i , IN THE EVENT OF VISA ALLI 1 01923557787 _ BY-�% CO1 rO AER REFERENCE !INFORMATION t 1 ' I(24 I Customers Authorized Re presentative a THIR AC,RFFMFNT rONTINI IFR CIN THF RFVFRS,F ginF