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milliI 1301 Gervais Street,Suite 300..;. 1+,Lr _ DUNS NO.05397-6551 FED.ID NO 396090019 CUSTOMER. ,.... a • SCHEDULED, FOULED-- Columbia,Southtialolina 29201' , L L ) �, C. FOR SERVICE CALL�, ? •' BRANCH MANAGER ?,J :DOC.EXP. < R,,�WEEK TRwTORY 11111.1 CUSTOMER NO: a, }_ .I7 ° �$� , �t;i r • r y;: S V1 f•1.r1; 3. 6{ f °' n'i' e' i,ii a " 2 - 5 ~ PREVIOUS BALANCE CREDR 0 f�?8543 - i:..^ i S: lMT�e'nvw, r v. -✓ - u r a y;, `: r.st4t}mWc1,iR-a'...-•r i .-. CODE - - a _1" vV4 a'.i; t r id.. t lih-V 11z� t'Fl:' .123 .r:.e°;9A ,� M.. _ ;• -'? .. EL ;J "' = - t` I BUSINESSI t M O N K E Y S R V INC TYPE CHAIN ourER ' SVC.P/C' PROD.`PIC 248 S AIRPORT MAY a 03 10000 010316110001 I X • PO. BOX 623 • LOCATION TAX EXEMPTION NO. a ' M NT A CA 9533L 0 SERVICE DATE SALES REP N0. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE CODE G Co I SERVICE TAX C.O.M.S.TAX PRODUCT TAX . 7- -0 P09-239-9571 1 05-195-4995 Pwl . 075 075 SERVICE/ HL REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE cwwcE INV. PROMO MSDS DEPT PRODUCT N U UNIT PRICE DUAN. CHARGE TAX CHARGE MIN. CLEAN SPEN f°F SK DOT CC TERM SER sa DnrL CODE NO. IRELEASE N O GIVEN 1Y ri t C.T{ coNT I m w.n 0r3000 0�4:364L 1 169.45 0. 00 169.45 0.0 2 80 12 J 3'7 El00100001 2 9000 0 ❑ } 0 Elr. �.. ❑ El Y � Q El p nr ❑ 16 f.4 5 O.U U 5 0.0 U CHECK GOOD POOR NO DECALS IN PLACE Y S NO MACHINE PROPERLY gi0Ut�1ED TOTAL-SERVICE/PRODUCTS APPROPRIATE 'MAH, CONDITION AND LEGIBLE_ ❑ ❑ /�� BOXES 8 CLEANLINESS ❑ LOCAL PRONE NO.STICKER Z RISIBLE LINK ❑ AFFIXED TO MACHINE ❑ w USEPA TRANSPORTER 1 ID NO. USEPA TRANSPORTER 2 1D NO. GENERATOR USEPA ID NO. - GENERATOR STATE IDf4O. ► LAMP ASSEMBLY EMERGEINSTNL�Y COLOSING n SPENT SOLVENT MEETS C 4 0 0 0 0 7 515 L CAL 0 O D 0 7113 3 CONDI ON OF LID UNOBSTRUCTED 1 ACCEPTANCE CRITERIA ❑ 0 CON-AINERS 10. TOTAL 14.UNIT r I 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12. sxDorNUMeR 5 16 30 5 5 WASTE I CERT IFY THAT MY TOTAL STREAMSARE WITHIN LL TASTE COMBUSTIBLE LIQUIDi N.O..Sr PETROLEUM NAPHTHA 4 NA1993 DPl G 801 - ONE OF "� FOLLOWING � CATEGORIES. G III RQ" D001 ERG#1280.6.7 LBS/GAL D018, DO39. D04Q DTo 220 LIBSJMONTH p . - .• 220 LBS.TO 2,200 LBSJMONTH. Q INITIALS W .j . �•.` GREATER THAN Y100 LBS/IAONTH -J ;r Nom, /• .. INITIALS QO DESIGNATED FACILITY NAME AND ADDRESS SAFETY—K L E E N SYSTEMS. INC. EICERTIFY THATTH R IN THE�CHARACTERISTICSGEOFF THE OCCURRED USA EPA ID No. C A T O Q D b 13 9 6 8 Q 5 Q 513 S A L I D A 8 L V D S A L I D A, C A 95368 AS�MATERIA SN THE PROCESS GENERATING THE STATE ID NO. C A T O G O 613 9 6 8 w 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 " V 2020 h '4 - OONDfipNS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) 'CHECK NUMBER E]TODAIS SERVICE/SALE 2O 3 PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE �Q INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDNIDW SIGNING THIS WASTE MIN. W Q ❑PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE r DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. n' - • (FROM ABOVE) r•,;, w,ti INVOICE# AMOUNT$' INVOICE# AMOUNT$ LDR REL[ D. `b "�I m..00n+w.e.rsw.�.c•awM B.rIW v�awm.nra.a.,e roaise..w r.M Rop.oaalmmaUwwWm, drouto*pkdAo.amQ.amDep �.dTn ponrm. TOTAL DUE PREVIOUS -- MANIFEST CODE SEO# ` •- DO NOT WRITE IN THE AREA BELOW CREDIT p tr� JV �II I SUhI ARD N ` L,Y �� Print Customer Name --1 1 1 1 1 1 CREDIT�C-. NO. --� 7-7 7--11 AMEX . i i I i ! ' I ' I I VISA ' I I I i