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vwltrti NU. FGR SERVICE CALL BR " eaeu,uuty BRANCH MANAGER CU.STLiey?-, DOC.EXP. SCHEDULED SCHEDULED C LL 0 U SERVICE WEEK TERRITORY _ C 3 7 0 2 _ 09-545-1011 JER Y AN6 RGEM 2 IJ 1J2 02-09 03 i 00201418 r S . MONKEYS P V, Z N CREDIT $ v I PREVIOUS BALANCE. M S.-AIRPORT' Woy = R . P O j�O t7r` �(� -Y BUSINESS CUTER 3 .* TYPE CHAIN o UNTY SVC:P/C PROP. MAMTE'�A''.�A' 95331" = 03 0000 SERVICE DATE SALES REP N0, f M 0' 03&1 C 00 CUSTOMER P.O.NUMBER LOCATION TAX EXEMPTION NO. G� CUSTOMER PHONE# TAX CODE IWJDLNG 7 1 a C Q 1 CODE ASSOC. SERVICE(. 0 9—2 3 9— cooE SERVICE TAX C.O.M.S.TAX PRODUCT TAX 9571 05-195-4995 W '� PRODUCT "° REMARKS/.: - O 7 7 S e' N STM B UNIT PRICE! DUAN' CHARGE SALES TOTAL • 7 7 S 1 © C00 TAX CHARGE WASTE SOLVENT/DRUMS CHANGE E� O U 4 3 6 4 2 SERVICE CHU CE lr 17 4.8 5 " Q 0 0 MIN. CLEAN SPEN cow. SK DOT CC TERM SERVICE TEAM zK 617E RA!. PROMO 2 U 1 00001 i 1 7 4 }I J (WEEKS)(INITIAL) M"j CODE NO 3 t �. ' 2 970Q Q 0 CC 2 801 12 �ELEASGN0 r_ 1 I s C . 7 , ASK ME ABOUT; IE 8 Mail-BackSharps! I r s Mail-Back Mercury! 10 ., More Inforrnptio 7 C 1, es/No E 12 :.:, Call our local 5af -FQeen Office C ' TOTAL-SERVICE/PRODUCTS ❑- 174 .85 0.00 174.85 USEPA ..! ... .8 5 C,0 I_ CHECK GOOD POOR S NO ❑ TRANSPORTER 1.ID NO. USEPA T APPROPRIATE MACHINE COND T ON DECALS IN PLACE TRANSPORTER 21D NO. GENERATOR USEPA ID NO. BOXES 1:1 AND LEGIBLE El MACHINE PROPERLY GROUNDED NO S C R 0 0 0 O 7 S 1 S(], GENERATOR STATE ID NO. —► a CLEANLINESSLOCAL PHONE NO.STI(," ❑ ~ RISIBLE LINK Z ' 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME C A L C 0 0 C 7113 3 LAMP ASSEMBLY .'INSTALLED ❑ AFFIXED TO MACWN� ❑ CONDITION ❑ EMERGENCY CLOSING SPENT SOLVENT MEETS Cw d A S T� C 0 r'I I3 U S t I B L E HAZARD CLASS,AND ID.) DE DD UN TLR0UCTED ❑ ACCEPTANCENT MEETRLA c LIQUID, S 2 CONTAINERS 13. TOTAL 14.UNIT ❑, A I R Q D p I j y` , E P • P E T R 0 L E U f1 �� H'r A ry ANTITY V L SY,COT NUMBER J I CERTIFY THAT MY TOT V 113 8 6 7 LBS/GAL D 019•D 0 3 9 t~1 F 1 ,9 3 D r C lJ WASTE $TREgMS ARE WIR I w. B. y- A O 1 CATEGORIES.THE FOLLOWI J .D040 777? L o o O C. Z .. _yN LS Y 220 LBS.TO 2.200 LBSJMONTH V D. INITIALS Cn GREATER THAN LU 2,200 LBSJMONTH J DESIGNATED FACILITY NAME AND ADDRESS U b 5!750 SALZDA BLVD SAFETY-KLEEN SYSTEMS S A L I D A, • INC, I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED INITIALS — Q CASH C A 9 5 3 6 8 EITHER IN THE CHARACTERIST CS OF THE WASTE USA EPA ID NO. C A T O O 1] a ❑,,.. TOTAL RECEIVED APPLY PAYMENT 70: MATERIALS MATERIALS. THE PROCESS GENERATING THE 6 b 3 ,6 C Z m CHECK NUMBER =i- MANIFEST NO. I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS STATE I D D O 7oT(ACF qD 0 0 6 13 9 a� ❑TOUAYS S CONDITIONS SET FORTH 6�� w 9NT ,�I ❑PREVIOUS BALANCE A$ O �� PLEASE CHARGE ��D ON THE REVERSE SIDE OF THIS DOCUMENT. _ r AMOUNTS LDR MESSAGE e, INDICATED IN THE PAYMENT ECEIVED SECTION. THE INDIVIDUAL SIGN SIGNING WSS (FROM ABOVE) �-g INVOICE#r•• DAB: k. 7L:. DOCUMENT 4 �L= L i— , _ INVOICE* L D R".REQ _ 'n+4 4 b urery MLY AUTHppIZEp 70 SIGN AND&NO CUSTOMER TO ITS TERM$. (FROM ABOVE) �''' ! Y PREVIOI �'I't•'I ?« r- t,� AMOUNTS WASTE MIN., > CREDR IS3 S `±'�f aJF D P.M MON.tr m.b.b: cra•ea.v+ro.a"-k d.1 ro.I.e.re w In r ' a. MANIFEST CODE SED# dam.a0ntr wTrr p,p , N CREnrr CARDt tt, ;- TOTAL DU _r r NaNo r46 V DA Prir)t CustomeE vrU DO NOT WRITE IN THE�IREA BELQW e CUSTOMER MC} , IN THE EVENT• t .. t' INFORMA _ CALL / 0112 0 t i 8 5 6 ' cDs 0000- 7 E E I f; r E Authorized Representative 3 Q 2—5(? —19