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I A. B. C. D. Columbia, South Carolina 29201 � FOR SERVICE CALL BRANCH MANAGER DOC. EXP. SERVICE EEK TERRR6 D �S�t"!i•r'6d4. CUSTOMER NO. a % t : — —� — T q�. 4 -� T �„ �( r � flflc 4160'3 � r'j 101U101047— I�J7:1 CREDIT CODE PREVIOUS BALANCE A R 50 JAY'iO ry — 7 BUTYPEss CHAIN NU OUTEn SVC. P/C FROD. P!C 942 S STOCKTON AVE 09 it 00 NO � n r, T i, A T T N ACCTS PAYABLE � LOCATION TAX EXEMPTION NO. RIPON CA 95366 -t -?784 718501 _ SERVICE DATE SALES REP N0. CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE HANDLING Assoc. CODE CODE SERVICE TAX C.O.M.S. TAX ' PRODUCT TAX 85Q3 — - ji 9Sq. .. 2"-t l 05-19-5-7269T 3 w 77 .077; SERVICE/ SERIAL REMARKS/ DEPT DUAN. CHARGE SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE CwGc INV. PROMO MSDS CC SERVICE TERM SCK DATE PRODUCT � r M - UNIT PRICE TAX CHARGE MIN. *OF TERM CODE NO. CWEN CLEAN SPENT ..OM. SK DOT (WEEKS)(INITIAL) 0Y 'NMREL EASE N !�' i a 4, t r EIr non aAnAAAAA r7 _ I❑ c 010k-5995 32 nn1 r 00100001 L y` 4..� �_f i D i -- I _ — �110 — ---�rr.. - — TOTAL-SERVICE/PRODUCTS CHECK GOOD POOR YES NO YES NO DECALS IN PLACE MACHINE PRu^PEFIY GROUNDED (APPROPRIATE MACHINE DONOR [] AND LEGIBLE ❑ U L S LOCALPHONF NO.:; riCiTR BOXES. &CLEANLINESS FUSIBLE UNK rt �-� � INSTALLED El AFFIXED TOMaCIBNE ❑ C! i U USEPA.TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. LAMP ASSEMBLY � � EMERGENCY CLOSING ^I SPEM SGLVt,T MEFlS I -T CONDITION 9��, At,�1Ll 1 9314 ! OF LID UNOBSTRUCTED L -I ACCEPTANCE CRMERA >�oL�� 11, US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD GLASS, AND ID.) 12. CONTAINFRS 13. TOTAL 14. UNIT 1 CFRnF'! tHA.T MY TOTAL N Wr ,OI SK DOt NUMBER t, ( i 'WgSiF_ STREAMS ARE Vvint' �1 /-,vy $4.47 d if aav,e sJ45T� ^k �7L 1 Q �' © S . ({%j G"�v y -,vA i � ONE OF THE FOLLOWIN � j 'may CATEGORIES. _ �v OTO 220 LBS.1MONTH z I I INITIALS _ 220 LBS. TO 4200 Lks.1rn q GREATER THAN 2,200 I.BSJMONTH —% Co L7 L �+ l+�I E" tp�y .�. 3� -� D EOI�'XNATE4i1,FgC»U—I L� -A' `_1470 / � ^9:: ` ! '" ,{ �y %-'? i t•Jp e,,.- /� '6,' �,✓, }r �'..? TO/l / �% �"¢•,rJ 1 GER11FY THAT NO MATERIAL CHANGE HAS OCCURRED C EITHER IN THE CHARACTERISnC3 OF THE WASTE USA EPA ID NO. 7 X '�'7 � '�J � , _,., MATERIALS OR IN THE PROCESS GENERATING THE -^7 -ry WASTE MATERIALS. STATE ID NO. 7 YO 0� • TOTAL CHARGE I V r C H TOTAL AEC VED APPLY PAYMENT TO: t.5H; ^^ M x kVA 8 a �•� _ TODAY'S SERVICEISALE MANIFEST NO, / �� �j f%(/ fi' C %'� I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE:) I F- PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE - - { � ric INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. i < PREVIOUS BALANCE AS FOLLOWS I TERMS. - �OL LDR MESSAGE DOCUMENT IS DULY AUT'HOR17ED TO SIGN AND BIND CUSTOMER TO RS (FROM ABOVE) �,/�, "IFJ� ✓" "'+f""�""f"' WA- $" I C E # AiviUUNT$ tr�'D'R NOTEQ' D lbm Is to s rty Nal Ne abwenema0 —lerlela are N Iasollled, P ka9eC. —ar -c! : Lod anol ara n -o-o—uar�sPcnaxn�`—TVmeVpraraereamer ofIrreoep—tofTranM,Ugon -• TOTAL DUE - _`,fU� { ` "" MANIFEST CODE SEQ # �� / /f DO NOT WRITE IN THE AREA BELOW TT LC ` I I CARD tv ( i _ ! CARD CREDIT CARD NO. EXP. DATE _ 7 7 Pricjt N017 r— AMEX LlVISA { i _ I I I I I i I I MCA = IWTHE EVENT OF AN i/ 00241613281 By: " / �/ i l r.�� r 0000-3717-96 -8 CUSTOMCR HEFERENC= EMERGENCY CALL Customer's Authorized Representative INFORMATION i I II I I i ' r r r THIO A(.RFFMFNT r.r)NTIMI IFS nN THF RFVFPPF gir)i=