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5400 Legacy Drive,Cluster II,B3 800-669.5740 DUNS NO. 05-397-6551 FED,ID NO. 396090019 CUSTOMER <br /> Plano,Texas 75024 w .safety-kleen.corn FOR SERVICE CALL BRANCH MANAGER DOC.EXP. scxeoULED SCHEDULED <br /> IIII1�iIlAl. CUSTOMER NO. Errol EwEEK TERRI ORv <br /> ''7 _) 209-545-1011 RUBEN MARTINEZ 05 P100279422: <br /> CREDIT I C y' /3, ; � — C. CODE PREVIOUS BALANCE <br /> 5 I jJ c�SA�L�!Q� ENGINE <br /> BS DOTER <br /> oE GRAIN coDNTY Svc.we PROD.Prc <br /> M <br /> f4 Yfleo V/ /� LOCATION TAX EXEMPTION NO: <br /> R ' /C SS.3C., <br /> 71sso1 <br /> SCODE <br /> TE SALE EP CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE GoHANDLING SERVICE TAX C.O.M.S.TAX PRODUCT TAX <br /> SERVICE/ SERIAL RWAU S/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE cxnxM MSI <br /> DEPT UAN. CHARGE <br /> *OF CC SERVICE TERM s1.GRT irve PROMO <br /> PRODUCT UMBER IINT"4�PlP4€IC TAX CHARGE MIN. GLEAN SPENT coNr SK DOT TERM IN mYWR CODE NO. GNI <br /> 5 <br /> 7 <br /> B + IE <br /> 9 [ <br /> t0 <br /> 11 [ <br /> 12 [ <br /> CHECK GOOD POOP YES NO YES NO <br /> TOTAL-SERVICE/PRODUCTS ,��(�. �J©' "7, APPROPRIATE MACHINECONDInoN ❑ ❑ °E ANO LEGIBLE ❑. '0 :/LouLPxoNE xo sncx°R'°x9sD ❑ ❑ 16— <br /> BOXES 6CLFANUNE33 PLEBES LINK ,❑ ❑' ALPHOENO SNE ❑- ❑ W <br /> USEPA TRANSPORTER i ID NO. USEPA TRANSPORTER 21D IN GENERATOR USEPA ID NO, GENERATOR STATE ID NO. --1 LAMP ASSEMBLY ❑ ❑ EM INSTALLED <br /> �.3PENTsEDTOOLVEACHIGMEETS �d <br /> /- _ COMMON ❑ ' 'ACGEPTANCECRITERIA ❑ ❑ <br /> TXR000050930 `5/ ,< GuD UNDBJROCTED )'• O <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS, ND ID.) 12.CONTAINERS 13. TOTAL 1A.UNrtsk Dor UMBER T 1 3 )5 1 CERTIFY THAT MY TOTAL IiJ <br /> NO, TYPE QUANTITY WT OL ry WASTE STREAMS ARE WITHIN <br /> 4 ONE OF THE FOLLOWING CATEGORIES <br /> / / / 0TOS <br /> 0 TO 220 LBSMONTH O. <br /> 41SL4 L' EJ <br /> -- INIrwLS Y <br /> 3. 220 LBS.TO 2,200 US MONTH U <br /> a <br /> ____INITIALS W <br /> GREATER 2pp 5 9NTH LU <br /> DESIGNATED FACILITY NAME AND ADDRESS SAFETY—KLEEN SYSTEMS, INC. I CERTIFY THAT NO MATERIAL CHANCE HAS OCCURRED USA EPA ID NO. Q <br /> EITHER IN THE CHARACTERISTICS OF THE WASTE <br /> MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. LU <br /> WASTE MATERIALS. V <br /> 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 <br /> CHECK NUMBER COM❑TODAYs SERVICNSALE 7 . Z PLEASEIONS SET CHARGEFORM MY ACCOUNTAND FOR ON THE <br /> REVERSE TRANSACTION <br /> OF <br /> OTHERWISE;i !(FROM ABOVE) • Ir <br /> ❑PREMOUS BAVACEAS ROLLOWS INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. W <br /> LDR MESSAGE OOCUMENTIS DULYALTHORIZED TO SIONAND BIND CUSTOMER TO ITSTERMS.," (FROM ABOVE) LU <br /> mAtwm,M Gd IM e0.wrvM mm✓ab ve PRMNmeoR,m.weroc].,wweM leMied,erd e'e In �l I <br /> INVOICE AMOUNT$ INVOICE IF MOUNT Pmm o.,ma evePwVlbncmdMmm�eI.,.V,ml�.ame mP.,e,.mmT,.,eoon.len TOTAL DUE <br /> fJ'�� <br /> CREDIT , _ _... ... '. MANIFESTO D SED# /J , tYtt DONOTWRITEIN THEAREABELOW <br /> CREDIT C - <br /> CARD NO - 1 4 V <br /> CREDIT CARONO. AMEX EXP.DATE Pxnt Cus er J me H <br /> vlsA � 7 MU02704222 <br /> MC <br /> EMERGENCY CALL 006E+91 <br /> By: <br /> CUSTOMER REFERENCETTTTTTTI <br /> ` CuelomehA Izetl RepreserRetrVe <br /> IM�(1RMAT(1N1 :11A•: ,1 <br />