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OCT 24 96415:26 FR SK 501 209 545 3680 TO 4649215 P,08
<br /> 1000 Nor),P
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<br /> .,7�SJ sI'�r'� w<w nriah.q Y"Ke'.a .EEr EflflGE rar.lnom- Y(IIMllt '. . .•
<br /> 09+6r6-117 =,Hf1iCLE[5ilt 'Q*4� '„ Tle.ia
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<br /> SERVICE OAT& SAL,ESMBISMO. SALES TAX pI>6AIPTIOFI NIAABER , .:.... ;- ,..-.. . � ..:• ,Malgra, :y.a� :,•�-q��::
<br /> IlMlorul■� cnear,>
<br /> orae � cme �SALE$TAX COLE-
<br /> 4j'!�
<br /> : .
<br /> ..7 C ..05"193-11487
<br /> 1M . 10011" >ERPAC7et c
<br /> .. . PFIODUCr.TAX t__
<br /> 5428 r::?' '.vliE ra =.:,'d ..ro':r>rA`,cyey 39-i 6Qn�92'S7;4 a :. aaa'
<br /> SERVICE SALE$ . . TOTAL eauw+r � n e aveee ��
<br /> SEA ;NO. SERIAL NC. CHARGE TAX CHARGE c�A�sve+r STEAM . „�'°' an Ama I ,-,. ,.; RENpF� : -$32
<br /> t7Y'�7:01
<br /> 39 Y4i5 ”`"�I "S✓S 2 X -..E' " Q$EA' NSE' •. fC
<br /> _wqq XX X .d :;o¢ �•: LEll+itr •.•::.n:::,.�
<br /> ' f7 d02Y8 74 :
<br /> .. ,' . . .3.Z ,. :,. 80.2 X"1F X �._ - - El.EC.... Hq... .
<br /> S
<br /> 7 5 .:..5....7. . BD .2 'X K, .:a. '..3'AK 3HCp : ..
<br /> Y7S-3239 '~74:5 :.9.7 8+3:.12' %YX .::b. .. pCtF 'SHF' .. .
<br /> -::::103r5 .s7 d:br'130r� Y:i4• 'ai::e... .:.i;. : .1iK $Na .
<br /> .-S93�ed�s�' .• .t 2' ?�'.T" ""1t1i:#, Ft7t' 7C ."d" . "`. - G .11A2N'E
<br /> IiV
<br /> � p
<br /> a"
<br /> ' .',..
<br /> ocP■ KIP '® n ❑ ❑
<br /> TOTAL K
<br /> nu�lnemwma■ ❑ Q xo Q F1 xnylAw[:nawato
<br /> rc,SERVICE$EC710N'i•.,:-: 9'aT9�7 ?ZOO ..1OAi'i:78 °"` '� :: � �' ❑...❑ ...: rora .::
<br /> (PIFAgCHECKAPPROPRIATESOMESONAIMM - a` m:u .❑ ❑ D :Y1=w ,❑ - ❑ self : ❑
<br /> TL-.98.xgC92'12 �aanl�. ,�T�i. -
<br /> Ii.U5DOT DESCRIPTION (INCLUDING PROPER 6NIPPINO NAMHAZARD OLAS%AND ID)��p xTanpp � uV �r as apr,Wla¢r;p ass ..
<br /> TASTE CaNaLST78L9 LIgUIDp h.Q,S. i .. a 1'6 5 U .3 *rw
<br /> 1T�f ADlE1JM 1�AP1a•''({kA) i�tA1,Q:93 R;6.LIIS,A.9ii.11 DM G 5a1 wale o
<br /> '0&*d°Ai 4948 iaa18i6aaa;,nibT 100 0,0413's tEd'6112T}'k ..r.:L v. -": �TAUTYN
<br /> Q !WASTE CCM9US? 1BLE L1QU1t31K.Cs9, F—
<br /> awAmm
<br /> pET7QLEU'� NApHTh;a3 �A294.1 Fr;3i12 :;C11 a� . �071
<br /> tl096■C:;.9A3u13■u�.3ci ■3u�';■ •i 471L�7Gi127I ._ LL
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<br /> .rr ro L :4.
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<br /> SIGNATEDFACILFiYNAMEAND.ADDEieSS SAP L°T.T'^16L '4ip�- ' :' UF3AEPA ND. CAT909a:119a8'
<br /> Lu
<br /> PFODUCT SALES FECTiONa
<br /> ,.rte • ; „I:,�- or
<br /> vnoa:crMA�. ... sw:m Na . 'r' �nr�s>,:'�ywvhfkr":•z:n'n+r -.. .rva 4ncer}.:... Mlir'. - AMmxr -+eY•:n::•• ::^.-ulamru - ,C
<br /> Wii!'P S,'o•.�. i � At
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<br /> . L7 iaru REc9■ED .APPLYPAYMEIMICt .
<br /> tAEN g�q, �T
<br /> .. TOTAL.P60DUCTS AMOUNT
<br /> 1
<br /> -. ,Q Pa'evnm■usu�xsmunwe LYA "TISEFDWH YOYdL SERVICE M/OtRlf :.''"� �.y
<br /> ED D
<br /> (PROM ABOVE)
<br /> AMOumT Ar/u -
<br /> 651 TOTAF_IXJE �.
<br /> .. H s
<br /> MC y gg
<br /> IN�MINlAtE�
<br /> CONL
<br /> OCT-24-1996 14:15 209 545 3680 1' P,08 LL
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