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11177Z— ....,..,--- —21 1t"C.11- —vv a vfYfL9 I Columbia, South Carolina 29201FOR ITT SERVICE CALL BRANCH MANAGER DOC. EXP. SCHEDULED SCHEDULED CUSTOMER NO. SERVICE WEEK TERRITORY 112/1' 0':i 14 (��FLP�qU9545,-L r Ji1' G Cu u Li _ U CREDIT PREVIOUS BALANCE CODE BAL OY R 60 AYS _ F _ _ 91019 T O BUSINESS I ER CHAIN �OU SVC. P/C PROD. PIC 942 S STOCK ON AVE Lig �+ LfON NO Ll793- 06001 E ATT % A C C T'3 PAYABLE R LOCATION TAX EXEMPTION NO. RIPON CA 95366-2784 7 1851:'1 _ SERVICE DATE SALES REP N0. I CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE HANDLING Assoc. CODE CODE SERVICE TAX C.O.M.S. TAX PRODUCT TAX ICS f'7- r3 1-;r 3 11850 5 _ _ _ 12'9—S`99-1 Hl 1 -5-195-7209 1 PWI L77 IAL DE SERVICE/ ' ^ REMARKS/ QUAN' CHARGE CHANGE "MME INV, PROMO IVISD> SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CC SE=RVICE TERM SOH. DnTE PRODUCT y U A L �;, UNIT PRICE TAX CHARGE MIN. s TERM CODE Np, R E L E A S L ti • GNEA cIEANSPENi .,;: SKDOT tw�BKSIIwrrL6i.l m '1 1 1 i 1 T uutL L � i -:�tJ.i: U ❑ 2 ULi .,,f ?147 1 • UG L1 L_ r ❑ i L d i, s..y ❑ s T ❑ 7 �. '2 �2 ' 1q. C7CJ F ET ❑ PTOTAL-SC-RVICE/PRODUCTS El - •) CHECK GOOD POOR YES NO NO DECALS LEGIBLE ❑ MACHINE PROPERLY GROUNDED 111 ❑ APPROPRIATE MACHINE CONDITION j ❑ AND LEGIBLE LOCAL PHONE N0. STICKER f BOXES g CLEANLINESS FUSIBLE LINK AFFDE9 TO MACHINE El ❑ ❑ 19- USFPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 21D NO, - GENERATOR USEPA ID NO. GENERATOR STATE ID N0. —+ LAMP ASSEMBLY INSTALLED EMERGENCY CLOSING I SPENT SOLVENT MEETS r—I 2 �..,.:J �I�zw :: _, r rT:1L.. II CONDITION ❑ Y :_,yLJ Of UD UNOBSTRUCTED ACCEPTANCE CRITERIA ii 11. US DOT DESCRIPTION (INCLUDING12. (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.) CONTAINERS 13. TOTAL 14. UNIT SK DOT NUMBER 1 Jr 1 CERTIFY THAT MY TOTAI NO. TYPE u NTTTY WT WASTE STREAMS ARE WITHIN +`a."I ! aR yr"' (.ry? G/' + f v ,�� • 'T �" �`� L 1 /� �[,�. (1 , ? .i':i'✓��iiJ-.�T �y q -7 f j' --r'+:�J /"'-CY �'� ONE OF THE FOLLOWING CATEGORIES. j S I 1 i `i f l j / J / 70) 7 V, 0 TO 220 LBS./MONTH 0 r T - - ' ReCeipt Datef r— INITIALS ± 220 LBS. 702.200 LBy",dML Q No. INITIALS ,� s.P.O. J GREATER THAN 2.200 LBS./MONTH Q C Line No. INITIALS C DESIGNATED FACILITY NAME AND APDRE,SS Receipt I NO N TF.c C GE HAS OCCURRED USA EPA ID Doc. OF TFiE WASTE NO. i ra?� d,C7 7 Z e Q ? 0 t'� - r�C C � I LU77 J of> i?,� 7u 7�Zv% ;'_ MANIFEST N MATERLAIS OR 1 CESS GENERATING THE WASTE MATER STATE ID NO. TTF7lTT TO BE BOUND BY THE TERMS AND CONDITIONS THE SIDE OF DOCUMENT. '' CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: Q C TOTAL CHARGE - I' CHECK NUMBER El TODAYS SERVICEISALE _� �y <'� : O ! - SET FORTH ABOVE AND ON REVERSE THIS PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE (FROM ABOVE) i �' 2 E] INDICATED IN THE PAYMENT RECEIVED SECTON. THE INDIVIDUAL SIGNING THIS WASTE MIN. -- a LDR MESSAGE R N 0 i - E -Q D 1�!Ous PREVIOUS BALANCE AS FOLLOWS DOCUMENT IS DULY. AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. I na s Io cin ly a. ft ebova—a memriav em pwMy d -SH ed, I,.� pd, marked end labeled. and are m merZakk.l W Ua pod bon e,�1n, w the eppik;ab r.g,lati�ne G lie DPar d f Tann fttr• (FROM ABOVE) I �— TOTAL DUE- 11 ' INVUICF. # f AMOUNT $ INVOICE # AMouNT$ PR,__ .__.CREDIT _ _ MANIFESTCODE SEQ# ! yam.15 {. DO NOT'%gR'—M IN THE AREA BELOW ^i Print Customer Name ,�, t £ CAEOIT CARD NO. — AMEX EXP. DATE VISA ' I THE EVENT OF MC J��IN EMERGENCY CALL ,_ ti.. _-.-i_. / `" 'L By: Customers Authorized Representative ! i.i� ... L:.' ..• [ i, ✓'61 T ya '°` U CUSTOMEP R _ � FERENCE ! TW14Z AhRCFMFAtT r`nKITIKII ICC nki TW= RFVCQCc C111= iNFORMATiOt•1 I ] ''