|
I JU I 2,7, Y 41L JU CCI ' JUIIG JW
<br />Columbia, South Carolina 29201
<br />sil q•9ieeD. CUSTOMER NO. '.✓
<br />vvlvq lrv. WVOI•'VJJI rcu. w rvv. OJOV.�IlV IO V V O t ; '
<br />SCHEDULED SCHEDULED 10R
<br />FOR SERVICE CALL BRANCH MANAGER DOC. EXP. SERVICE WEEK TERRITORY
<br />,.%E
<br />USEPA TRANSPORTER 2 ID NO.
<br />(GENER�ATORUSEPA IDjNaO. `
<br />` A L'L%ill'; 1,1(
<br />GENERATORS ID NO.
<br />1 i. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.)
<br />FtA-r.,4'rov'�'j 4s-rc j r -'s ,/v_v. S,
<br />I
<br />t 'F>Vc.2'7
<br />�-—
<br />WASTE MIN.
<br />S
<br />Q
<br />C
<br />1
<br />aaa`
<br />-
<br />• tjii l�
<br />I
<br />woa«canseoYjp mW-ii—dng ftavp�ey replan ,n W (?,p—(?,p—oray,ar nair am In
<br />nr
<br />'�^t
<br />CREDIT
<br />PREVIOUS BALANCE
<br />BAL. OVER 60 DAYS
<br />U
<br />r.
<br />_ i
<br />I
<br />PrQt Customerlpr�le
<br />{ �'
<br />4 a
<br />y7 2003.52
<br />.5
<br />T
<br />F.. .?"`I
<br />� F f 'f %
<br />CI
<br />8888
<br />! JL4
<br />02015734
<br />BUSINESS CHAIN -
<br />OUTER
<br />COUNTY
<br />SVC. P/C
<br />PROD. P/C
<br />O
<br />F
<br />942 S
<br />STOCKTON
<br />AVETYPE
<br />ti yr
<br />Li11 r €
<br />N �F
<br />M
<br />F
<br />A +
<br />ACCTS A
<br />Y A ?
<br />El
<br />LOCATION
<br />TAX
<br />EXEMPTION PiU.
<br />11
<br />RIPON
<br />Cry 95 :t 6-2
<br />8
<br />El
<br />7.#48501
<br />—.._
<br />SERVICE DATE
<br />SALES REP 480.
<br />CUSTOMER P.C. NUMBER
<br />CUSTOMER PHONE #
<br />HANDLING
<br />TAX CODE cope
<br />A ODC.
<br />CODE SERVICE TAX C.O.M.S. TAX
<br />PRODUCT TAX
<br />j f
<br />;'V
<br />'✓70—J
<br />(E_
<br />SERVICEI1
<br />�DEPI
<br />A
<br />REMARKS/
<br />DUAN.
<br />CHARGE
<br />SALES TOTAL
<br />WASTE SOLVENT/DRUMS
<br />SERVICE CHANGE - E=IRV .PROMO
<br />CC SL'KDATE
<br />MSD5
<br />PRODUCT
<br />NUMB'
<br />UNIT PRICE
<br />TAX CHARGE
<br />MIN. soF
<br />CLEAN SPEN SK DOT
<br />TERM SERVIcETtRM -CODE 480:"
<br />" EEKS INmAL PA' YA'0
<br />� E A S"` �t
<br />-+-w `Y
<br />GIVEN
<br />l
<br />2
<br />3
<br />4
<br />5
<br />s
<br />7
<br />8
<br />A
<br />B
<br />V
<br />IJ
<br />USEPA TRANSPORTER 1 ID NO
<br />�40 1 L),a Ll 3.bU
<br />USEPA TRANSPORTER 2 ID NO.
<br />(GENER�ATORUSEPA IDjNaO. `
<br />` A L'L%ill'; 1,1(
<br />GENERATORS ID NO.
<br />1 i. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.)
<br />FtA-r.,4'rov'�'j 4s-rc j r -'s ,/v_v. S,
<br />I
<br />t 'F>Vc.2'7
<br />�-—
<br />WASTE MIN.
<br />S
<br />Q
<br />1. -
<br />i
<br />G
<br />77-13Curs
<br />• tjii l�
<br />I
<br />woa«canseoYjp mW-ii—dng ftavp�ey replan ,n W (?,p—(?,p—oray,ar nair am In
<br />nr
<br />'�^t
<br />--'�/
<br />TOTAL DUE
<br />2T,-
<br />fap
<br />y Ifi i f
<br />�e
<br />DO NOT WHITE IN THE AREA BELOW
<br />PrQt Customerlpr�le
<br />{ �'
<br />4 a
<br />La 247 7a3�I.
<br />F.. .?"`I
<br />� F f 'f %
<br />CI
<br />8888
<br />! JL4
<br />02015734
<br />e L0 0 Q�
<br />6 8 4 0 OD
<br />'r"
<br />t _ —1 rEj
<br />El
<br />El
<br />009,5�57
<br />j f
<br />;'V
<br />'✓70—J
<br />(E_
<br />ece4 c.
<br />—
<br />❑
<br />TOTAL SERVICE/PRODUCTS
<br />/'
<br />f Rrt C� 70
<br />r ]�. /
<br />-y
<br />• r 0�. �)�
<br />CHECK GOOD POOH
<br />APPflCPRIATE
<br />BOXES CLEANLINESS e�
<br />YES
<br />DECALSI
<br />►E YLtINiK
<br />NO YES
<br />MACHINE PROPER Y GROUNDED (-
<br />LOCAL PHONE NO. SICKER � "`u
<br />NO
<br />�'(
<br />Z
<br />USEPA TRANSPORTER 1 ID NO
<br />�40 1 L),a Ll 3.bU
<br />USEPA TRANSPORTER 2 ID NO.
<br />(GENER�ATORUSEPA IDjNaO. `
<br />` A L'L%ill'; 1,1(
<br />GENERATORS ID NO.
<br />1 i. US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME, HAZARD CLASS, AND ID.)
<br />FtA-r.,4'rov'�'j 4s-rc j r -'s ,/v_v. S,
<br />I
<br />t 'F>Vc.2'7
<br />�-—
<br />WASTE MIN.
<br />S
<br />Q
<br />1. -
<br />i
<br />DESIGNATED FACILITMVAMF AND-ADDRE$�
<br />,Q �/I ;��
<br />_
<br />T"e t
<br />BASH ❑ I TOTAL RECEIVED
<br />INVOICE I AMOUNT $
<br />r --
<br />PREVIOUS--
<br />CREDIT
<br />CARD NO
<br />_ Cocnrr cern nen
<br />CUSTOMER REFERENCE
<br />;NrnRMAnnM i
<br />APPLY PAYMENT TO: MANIFEST NO.
<br />❑ TODAY'S SERVICEISALE ---;'a 1 I 10 l I
<br />I] PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE
<br />111.E # I AMOUNT $ "L_ D R NOT R E Q V, I
<br />h"A�CODE gSEO #
<br />1 1.7
<br />AME(
<br />VISA
<br />INSTALLED L -i Li AFFIXED TO MACHINE LJ u
<br />LAMP ASSEMBLY
<br />NDITION EMERGENCY CLOS7lG �,,.� ACCEPTANCEOLENT CRITERIA
<br />OF LID UNOBSTRUCTEDr� (�
<br />12. CONTAINERS 13. TOTAL 14. UNIT1 -'7 r I CERTIFY THAT MY TOTAL
<br />NO. TYPE QUANTITY WT OL SK DOT NUMBER ,� WgSTE STREAMS ARE WITHI,`j
<br />ONE OF THE FOLLOWING
<br />rq sy� � � � r?2 CATEGORIES_
<br />220P.IES.. ----sill 0
<br />C,•� /° 0 TO 220 L$j$>,/MC
<br />`. Z
<br />INITIALS
<br />220 LBS. TO 2,200 LBSARAO—,
<br />INITIALS
<br />Ld
<br />GREATER THAN 2,200 LBS JMONTH -�
<br />1
<br />cr
<br />u^
<br />INITIALS 0 C
<br />I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID NO. f Z a
<br />EITHER IN THE CHARACTERISTICS OF THE WASTE '� Q
<br />MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. ��` 4Y✓
<br />WASTE MATERIALS ) LU
<br />I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND
<br />TOTAL CHARGEr—
<br />I
<br />V M
<br />CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT.
<br />(FROM ABOVE)
<br />> i --
<br />PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE
<br />PLEASE
<br />INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS
<br />�-—
<br />WASTE MIN.
<br />S
<br />Q
<br />i
<br />W
<br />LU C,
<br />DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS.
<br />(FROM ABOVE)
<br />CD
<br />woa«canseoYjp mW-ii—dng ftavp�ey replan ,n W (?,p—(?,p—oray,ar nair am In
<br />nr
<br />'�^t
<br />--'�/
<br />TOTAL DUE
<br />I ,{ r
<br />y Ifi i f
<br />�e
<br />DO NOT WHITE IN THE AREA BELOW
<br />PrQt Customerlpr�le
<br />{ �'
<br />tz is
<br />La 247 7a3�I.
<br />Customer's Authorized Representative
<br />TLJIGl A/lOCC\IChlT r1r%k1T/L11 =0 rNh1 TUC 0G11C0QC QIrIC
<br />
|