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Plano,Texas 750,7 www.satety-klesn.com FOR SERVICE CALL BRANCHMANAGER [::OuLUU.vr.' 1 S E WEEK TERRITORY <br /> III- CUSTOMEh <br /> 2C) —S$5 14)1 RALPH `I' Ft !SSCi �L�: C. r 09—l'? 25 00369 $. <br /> CREDIT PREVIOUS BALANCE <br /> CODE- <br /> U �> �y OQ03-2646--64 D 216. 7` 216 , .1 <br /> T TRACY AUTO GROUP LII SEGMENT GI N OUTERNSVC.PIG PROD. <br /> o ir1 n NA'v`L 'E RT) 3460 f AUL ',', RD OWE ("000 \10 41 .rt( <br /> MLOCATION TAX EXEMPTION NO. <br /> E s TRACY CA 95304 TRACY CA 953°78 <br /> R . 71850] <br /> SERVICE DATE ISALES REP NO. CUSTOMER P.O.NUMBER -CUSTOMER PHONE# I TAX CODE DATE EQPT/PROD ORDERED I SERVICE TAX C.O.M.S.TAX I PRODUCT TAX <br /> •, ?i?�3-82�� l ti0 r35-135—�9$� RW <br /> 0,375 0 7:3 <br /> SERVICE/ '' REMARKS/ SALES TOTAL WASTE SOLVENT/ HUMS SERVICE CHANGE "w" INV. PROMO <br /> DEPT QUAN. CHARGE Tar CC TERM SERVICE TERM SM.DATE CODE NO. S r <br /> PRODUCT i JUMB E UNIT PRICE TPJ( CHARGE MIN. CLEAN SPENT CONT SK DOT EKS INITLAL m YAM RELEASE u Tis <br /> 1 002387 0. OD' 4 <br /> 2 009083 1 070513CS 1 .191. 9 16. 6 ?G 5 0. c O L '14911 <br /> 3 (. 092387 060245, 3 1 <br /> 010000S 9. ` 2 O 1 10. C 3 0. CO I <br /> VIe Aecycie', <br /> g - <br /> 7 <br /> 8 r: <br /> s � - <br /> 10 <br /> 11 <br /> 12 <br /> CHECK GOOD PDDR YES ND NO <br /> DECALS IN PLACE �7 MACHINE PROPERLY'ROUNDED ❑ <br /> f 5,jt 1..J <br /> TOTAL-SERVICE/PRODUCTS /^,j ?I t 'n9 � {t. �� APPROPRIATE MACHINE CONDITION d AND LEGRLE LOCAL PHONE NO.$TICKET/ 14 <br /> v f r .� B0 &CLEANLINESS FUSIBLE UNK ❑ AFFWD TO MACHINE ❑ <br /> INSTALLED —r <br /> OSEP4TRANSPORTER110NO. UaEPATRANSP.ORTER;2lON0. GENERAtOt "USl; 1DtO .YfaF.W RAy(1R 1ATE:IDNO. _' "� LAMP ASSEMBLY ❑ EMERGLNCYCLOSING SPENTSOLVENTMEETS rf7 ❑ <br /> T`SCR t3 0 0 0 5 til 3 0 ALC?0 0 3 3 2 3 5 4 coLIUmON of uD uNUBsrRUGTED ❑ ACCEPTANCE CCER IA IL E� <br /> 12.CONTAINERS 13. TOTAL 14,UNIT SK DOT NUMBER �1 6 E-CERTIFY THAT MY TOTAL <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND IN N QUANTITY—Wr a iATASTE STREAMS AAE YYPPHIN <br /> t t ^ 9 ONE OF THE FgLLOWING <br /> NON- RCRA HAZARDOUS WASTE, LIQUID � m LT � CATEGORIES,£S, <br /> 4 TO 220 LI TH <br /> A. ( ,AQ0EOUS .PARTS WASHER SOLUTION) ! Z , <br /> INVOICE # <br /> 220 LBS.TO 2,200 LOS.IMONT#i <br /> AGGT <br /> ACCT 3 q�� ' 3 INOFIALS <br /> C. GREATER THAN 2,200 LBS./MONTH <br /> INITIALS <br /> D. y[y�jr1/ <br /> DESIGNATED FACILITY NAME AND ADDRESS SA _F, N E tai,e I1•C. I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED USA EPA ID NO. C A 000 106 4 5 1 7 <br /> EITFIER IN THE CHARACTERISTICS OF THE WASTE - <br /> 60()0 a� SryTR y -4ACRY1MENTO CA 95828 MATERIALS qR IN THE PROCESS GENERATING THE STATE ID NO. 4.� 00irJt3S.��14 1. r <br /> rTe 11 y t"�' �' •Y~Cl ic7 L: 1 4J •7 WASTE MATERIALS. <br /> CASH ❑ TOTAL RECEIVEDtEISERVICf/SALE <br /> PAYMENT TO: MANIFE 0. I AGREE TO PAY THE ABOVE CHARGES AND To BE BOUND BY THE TEFL AND TOTAL CHARGE <br /> CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) <br /> CHECK NUMBER C..F - RGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br /> N THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL STONING THIS WASTE MIN. <br /> $ALANCE AS FOLLOWS LDR.MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMERFO ITS TERMS. (FROM ABOVE) <br /> • _ `rim h m units tlw me ei�araarenwd meterWN ue pmPwY daselA W.p.d�god.m Bed eM� Wd,w�a erc in , e�, �.•i ,� <br /> INVOICE# AMOUNT$ ? INVOICE# AMOUNT$ 3 A a =� 3 ,b,,,�,H„ � �s,,�g�cb m wR+91M.Dap."W aT +ma^ TOTAL DUE 7. r <br /> PREVIOUS MANIFEST CODE SEQ# <br /> r ! I r / DD NOT WRITE IN THE AREA BELOW <br /> CREDIT 1T� - r <br /> p PJ P�Int GY mer Name <br /> CREDIT CARD NO. AMEX E7(P.DATE `I f' v 0038964906 <br /> VISAIN THE EVENT•EMERGENCY CALL j p �/ .. ' ' t�0()3—2 —'� <br /> M B <br /> Cu s r' epresentatNe <br /> '`ERENCE <br /> :.s .E . r,„.c"„ 'cc 11NL TNF RFIJFRCF CIF7F <br />