|
ev
<br /> 11301 G`91Y8i3$VB6t+$UI19300 •M•- Ras �••+ ¢.-..e:. -�.�. �. .:,-•DUNS N 05-n7_6551` •^-:r=fED.ID NO 89809001 +��— .-.�..,�+VQ■��r 4.-- —'
<br /> ColumblB South C o11na 2920) . 1� 3 .01 A ���'�.�,(IA _K FOR SERVICE CALL � ?L'BRANCH MANAGER `�1�..: i-DOC EXP.•.)v 4, SOHm� - .gsa+EDul�n. 4
<br />'400.
<br /> USTOMER NO;' f,'JA P,l SERVICE WEEK 'TERR roRr `
<br /> IJ <.. .. : t ,! 0lT .,Ai4,l,4t41 jA1�i .rl aits:L.� sp �tthl Li t1t I
<br /> ' a••�` , as-� , ,- •-� •,� y . ..` _. ..:>, ,: ._>1 ,-: � 1"\� 1� �V
<br /> ' �8W¢n,�vtr - CODE. ,�PRE:VIOUS BALANCE
<br />_ �'_ . _ �- a:i tllRJ,i 8kf�3� YT3jj1 'i:ri �JtlL", r is S gwNR I OAA itS;it.�J) c'::! l -
<br /> tL t $ +J•/ f� r? 7 �. a3•1>» 0I 3J9 i!Ju 1A F ASN t?:S 4
<br /> L4r6 O az A, y:;r 5 BUSINESS' -
<br /> //! 1 ! I A .i H "d r!t '1 1 'OUTER $VC P/C.
<br /> c a: ,a, r, P5 qh7 + 'T ti + i n, r CHAIN PROD.P/C
<br /> PdZT;. tj
<br /> ,�*': ,¢✓) ��� �'� / • f • LOCATION TAX EXEMPTION NO.
<br /> SERVICE DATE ISALES REP N0.
<br /> CUSTOMER P.O.NUMBERHANDLING
<br /> CUSTOMER PHONE# TAX CODE Asp
<br /> -OL 2 cJ�� r cooE cooE SERVICE TAX C.O.M.S.TAX PRODUCT TAX
<br /> I
<br /> PT SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE
<br /> PRODUCT WAN. CHARGE aurE INH. PROMO MS0.S
<br /> UNIT PRICE TAX CHARGE MIN: CLEAN SPENT •OF SK DOT CC TERM SERVIOETERM DE /
<br /> r
<br /> NO. GNEN 1
<br /> i
<br /> ❑ l4
<br /> ~ } ,• ❑
<br /> EEII
<br />_ aI '
<br /> TOTAL-SERVICE/PRODUCTS a k, =,4j r.Q OHECK GOOD POOR YES NO YES I
<br /> APPROPRIATE DECALS INDUCE ❑ ❑ MACHINE PROPERLY GROUNDED ❑ p V
<br /> S MACHINE CONDITION p ❑ AND LEGIBLE V -
<br /> 8 CLEANLINESS RISIBLE LINK LOCAL PHONE NO.STICKER Z S
<br /> SEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2[D NO. GENERATOR USEPA ID NO.- GENERATOR STATE ID NO. •,' INSTALLED ❑ ❑ AFFIXED TO MACHINE p ❑ z 7(
<br /> . .LAMP ASSEMBLY ❑ ❑
<br /> CONDITION EMERGENCY LLDUNOBSTRUCTED
<br /> SP NT ACCEPTANCE
<br /> MEETS
<br /> IA ❑ p {
<br /> OF UD UNOBSTRUCTED ❑ ❑ ACCEPTANCE CRITERIA ���
<br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,A.ND ID.) 12.CO AWERS i7 TOTAL u.carr I CERTIFY T MY orAl k
<br /> G/ 'C QOM!3L . rs 4C I4 V%C4 A,1O•S. NQ oUANTrry SK Dor NUMBER WASTE STRE�IAI3 ARE WIT}W W
<br /> �'lJ.eo� rvn»��. /kPRrH/1 . j .
<br /> �t,�Y1Fgo i7c
<br /> r'L� nnlI Nryo)Og 7,9 ONE of THE �LLp1Nlq
<br /> . �,' vy, �. h / Q� CATEGORIES. {t�
<br /> 0 TO 220 LEISJIMONTH C"
<br /> � t 1
<br /> i1 fr+ J ' .•.H. - - .- i f -:b n•..;t_. �" ,. .. `4 I Sg at:_'. .i IATfc.,1.✓`.I'Y •I •_ .;� IT.W20.0S LSJM1.OFMB _.
<br /> ca
<br /> .i" tQ
<br /> i.
<br /> GREATER THAN 2.200LKAVM _J
<br /> N C�
<br /> ATED FACILITY NAME AND ADDRESS 0.0
<br /> I CERTIFY THAT No MATERIAL CHANGE HAS ocIxIRREo Z m
<br /> d EITHER N THE CHARACTERISTICS OF THE WASTE USA EPA ID N0.
<br /> MATERIALS OR IN THE PROCESS GENEMTNG THE Q
<br /> WASTEMATERIAS. . STATE ID NO. W
<br /> CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO;' r` IANIFl± �t0 I AGREE TO PAY THE ABOVE CHARGES AND tb 8E'BOLnaD BY THE TERMS AND TOTAL CHARGE Lda }tAbt �Iif. U chi
<br /> CHECKNUMBER ' CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. ABOVE) F-
<br /> ❑TOGAY'S SEAVICESALE 2 PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION LESS�ROTHCU ENT. (FROM ¢
<br /> :S WISE
<br /> PWMUS BALANCE AS FOLLOWS INDICATED IN THE PAYMENT RECEIVED SECTM THE INDIVIDUAL SIGNM THIS WASTE MIN. "•'{
<br /> VOICE,iR LDR MESSAGE t. DOCUMENT IS DULY AUTFHORLZED TO,SIGN AND BNo CLiSTOMER To ITS TERMS. FROM ABOVE) ' L
<br />'V AMOUNTS INVOICE! AMOUNTS a mr i a ar•h m.,n..eoY.wn.a m..nra w P0P-4 d.m.a roafw•e.m.nrw wW er.a..,e w n ( ;i,O k t9$Lt�i+am u*
<br /> �.: � aaprmlWw!au.nwrlm.cm.arocm.wc+�I.rvrau+ar. ,■.per,,.
<br /> MANIFEST CODE`' a ZgEQHY TOTAL DUE �}}� I s
<br /> £ / ate DO NOT WRITE IN THE AREA BELOW
<br /> DIT CARD NO. AMEX E7(P.DATE rn Customer Name
<br /> fir T� OF
<br /> VISA rIN THE EVENT
<br />
|