COMPLIANCE INFO PRE 2019 - Laserfiche WebLink

Home Browse Search

IleOne BTi{, 1Way _ DUNS N0.05106-0406 FED.ID N0.39-6090019 CUSTOMER WE CAW, SCHEWLED SCHEOULEO Elgin.111h, ,0123-7857 FOR SERVICE BRANCH MANAGER DOC.EXP. SERVICE WEEK TERRITORY GUSTOMER NO. ' p09—S44—LI'.LL VON ICA 3HANNO11 11 L/1 213-4' 'L 14t' LT 1 — 3 11 L) - CODE PREVIOUS BAIANCE A V 6 A J _ BUSINESS CHAIN OUTRR SVC.P/C PROD.PIC j C f1 y ;• TYPE COUNTY D ?4 V CHEROKEE Ot :-3 1 '1-1 ,: 7nL -1 . LOOT CA 9 5 r?4 3 LOCATION TAX EXEMPTION NO. ? � 7LSrJL SERVICE DATEy SALES REP NO. CUSTOMER P.O.NUMBER CUSTOMER PHONE k TAX CODE HANDL E G cage SERVICE TAX C.0-M.S.TAX PRODUCT TAX / - ^`T-334-3L! ^_S-1,'5-4698 ^77S SERVICEI > -' AL .t: A><Kb SALES TOTAL WASTE SOLVENTIDRUMS SERVICE CHANGE E wv. PROMO MSDS DEPT PRODUCT N(fMB,_R :JNTT ?;ZICFOUAN. CHARGE TAX CHARGE MIN. r.LEangsPEN SK CC SERVICE TERM v1.omTe c( _ li''�tt GIVEN F TERM IWE-KS nNMAL CODE NO. R___ 5 i'' -1• 77. 7 i..9 77.7 '. •7.u's L Lti -' � 7'- 'S ❑ 3 ❑ 4 ❑ El 5 ❑ 7 ❑ 3 ❑ a ❑ El El El r. j r 77.7 F. :f.U' CHECK DOOO POOR YES NO YES NO DECALS GBUE y(/ MACHINEPROPERLYGROUNOED ,6' TOTAL-SERVICE/PRODUCTS APPROPRIATE &CLEANINESS ION �❑ AND LSIBLE 'I-� ❑ SAL PHONE NO,BROKEN ❑ Z BOXES Br,LEgIryNESS RISIBLE LhR ❑ i❑ AFRXEDTOMACHINE ❑ W MANIFEST NO. USEPA TRANSPORTER ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO. UMP ASSEMBLY ❑ ❑ EME GEMI CLOSING I'� SPE"SOLVENTMEETS ❑ T L ii 99'a'0 3 C L A_I J'1'J C r 1 .�4 COMMON O LIDO BG PU ID J� ❑ A CEmAxcELR RIa Q 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS.AND ID.) 12.CONTAINERS 13. TOTAL 10 UNITSKDOr NUMBER - j 1 CERTIEY THAT MY TOTAL (L NO. TYPE QUANTITY WTNOL WASTE STREAMS ARE WITHIN J "NAS f CCM BUS T 13LE LT DLI10 N . S ( '- TL ='Jy "tAPH T4 ATI T'1AL 'I I J (} , U. '_ 't ONE OF THE FOLLOWING IT(OL)DL) ( DO7:a.D(liltl.0O6.9� 77�7f"1'y.7.'14r') ?GxL2�tl / / I CATEGORIES. To nonies.nONTH O Z INITIALS V 220 LBS l�$.2W LBSl1AONTH Q Vil`TIALB W GREATER THAN 2,200 LBSAXONTH Q m to m NITIALS DESIGNATED FACILITY NAME AND ADDRESS SAFETY—<1_FE4 'WiT•_>Vl T :tiy. USA EPA ID NO. CAT']GfJ{, L (,` Q¢ S]53 iALIDA °LV )ALT"•A♦ CA TS3'::1 STATE ID NO. - a ( 3 Wm CASH ElTOTAL RECEIVED APPLY PAYMENT TO: I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE CHECK NUMBER y� � CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) LJ IODAY'S SERVICESALE PLTH EASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OERWISE �D] 7 INDICATED IN THE PAYMENT RECEIVED SECTION,THE INDIVIDUAL SIGNING THIS WASTE MIN. a (/ �� ❑PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE DOCUMENT IS DULY AUTHORUED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) ya INVOICE% AMOUNTS INVOICE a AMOUNTS (_(1 Q Q=!)a -3 R:u:s�o mniN:n.�m..m...w,.e:wvmis ve n.w:M1au:Aea.vvaw...:,,.:r.o w seam,a:a.:.m , PEP.,mmaw:r«.I,.,:.P.:mem:.®,a:N rou:.mP ::ea�.Dmwvn®::nra:u'm�a2 DUE _ TOTAL PREVIOUS -. - _ MANIFEST CODE SED M ,� CREDIT — _ _ _ ... _ .___ . _ . _-._ .. .. LTJ l l 1U �"�. � � .✓ - �i ` V � 1, - I % DO NOT WRITE IN THE AREA BELOW ARD NO Pnnt Customer Name V CREDITCARD NO. AMEX EXP.DATE % i '14 L1,17 C - VISA I 1 1 �j pT�-<._,�! /^"� 7—� 3 7_ :(l9(J—C ' MC CUSTOMER REFERENCE DUStOmerS A.fficm ed Representative INFORMATION THIS AGREEMENT CONTINUES ON THE RE'/FRSE SIDE