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YLAt,:tmtdI rurcm <br /> COLUMBIA,SOUTH CAROLINA 29201 <br /> KJKJCKV1l.Glilltt <br /> 1 1 <br /> fll <br /> DUNS NO.05-397.5551 FED.113 NO.75-2178928 NAME TITLE SIGN <br /> GE R/�T©R Q� — (IF DIFFERENT FROM LO -�[Q�4),; 1 <br /> NAM _�:— <br /> t F i { v I Y'DDRE ' <br /> LOCATION <br /> i SIC CODE <br /> 1 z. <br /> ej! <br /> I � f <br /> ;.'� INFORMATI ATTEN ON LINE ).- -0a V 1 <br /> co <br /> L <br /> cIm y ) I { a�sTAT 1 I { I BUSINESS CHAIN ASSOCIATI SVC.PIC PROD.PIC <br /> TYPE <br /> qTY&STATE . F..._. ' <br /> co <br /> _ �- <br /> _. <br /> _. zAzsoDE P X�ODE —7--- SALES TAX EXEMPTION NUMBER <br /> s ay u"_"� HANDUN cr�rr ERVICE ODUCT TAX <br /> DA PLACED SALES RFP NO. Q BLANKET El TEMPORARY t CUSTOMER PHONE NO. cooE � S TAX G.O M.S.TAX PR <br /> CUSTOMER.. �r �y ` <br /> P.O.NUMBER `."_ �°".. � ���s <br /> SALES TOTAL SOLVEhtT/DRUMS sERw� scOEDUL[ r� INV PROMO RELEASEMSDS <br /> rte* E/SERVICSERIAL REMARKS/UNIT PRICE 0-14N. CHARGE TAX CHARGE EE—w "SPENT ca. SK DOT TERM SK NO. <br /> "IODUCT NUMBER E <br /> j _ <br /> ❑ <br /> 3 ,•_ ❑ <br /> T -H-SM - 1010 * R Puce�ON <br /> N�Ius[i s�Rvu <br /> To — - .. DiFFEC naa+lr� <br /> PI-ACEMENT-n REPLACE COA'P£TITIVFtVCQ;INE <br /> m <br /> CODES (41 REPLACE HOME MADE VAI <br /> i1SgpTRAt�GSPORTER 11D N0 l}5�?ATRANSPORTER21p N0. GENERATOR USEP,A lDNO. GENERATOR STATE'ID NO <br /> � I I�u•Ir�NaL MAunN <br /> At _ � <br /> X <br /> c° eT 1 C ' 72 CONT }3. TOTAL 14SK ppT NUMBER ! CERTIFY THAT MY TOTAL <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) nib" YYP QUANTITY WASTE STREAMS ARE WITHIN <br /> ONE OF THE FOLLOWING <br /> g� try ? �+ani g Y < �•�y� - !t.i Cs tea,T y�T t g L y �t t 7 0 � CATEGORIES. <br /> bLZ��t l i if a3 L S. Ss l '�3 1 s tal--. �. :5� ( P E TR.1 L+3i s m MAP H H A.g" i'FA1 9 9 !V O TO 220 LBS.IMONTH <br /> g Y �' g -- € p`. 3 —St 5lftf`it!'6 <br /> — .w� ..- s,t. m r ?'>O .� .- .v _ r INAIFlLS- <br /> �a h'.S.0'i +Y- ,.tS �+ Y 'l TS "•-�`t ., , ,t., •+ a z'""fs'S"! '"'� l - 220 LBS.TO 2,200 LBSIMONTH <br /> a a:T ' i i.6 •tae �..}- .�, -;;.=L L .S$'''+ �"i;t: -•�` = ..s INITIALS <br /> 201 <br /> - P ,.. �� •..r _ - + ,_�,.."z-'�'b.-`C `� '- �-s�'�r Cd2F3.T Rfi�LBSJMCNIFf � <br /> INITIALS <br /> o <br /> D�SIGNATED FAClLlTY NAME AND ADDRESS USA EPA ID NO. ' E - <br /> jj `� — L SYSTEMS STATE{D NO. <br /> "¢�r .� _ 0 <br /> CASE{ ❑ TOTAL RECEIVED APPLY PAYMENT TO. MAN#FEST NO I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTALCHARGE <br /> er 1 <br /> CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SDE OF THIS 130CUMENI- (FROM ABOVE) <br /> CHECK NUMBER - . PLEAS.CFIARGE-MY ACCOUNT FOR THIS TRANSACTION. UNLESS OTHERWISE <br /> L]TODWSSERVICEISALE INDICATED IN THE.PAYMENT FT-CE-13 SECTION.THE INDIVIDUAL SIGNING THIS TOTAL DUE <br /> -❑PIREIIIOIiSBN.ANCEAS FOLOAS LDR MESSAGE DOCUMENT IS DULY AUTHORED TO SIGN AND SINE)CUSTOMER TO ITS TERMS- <br /> - ...- "titin B tc cer6F!tt¢:Bie�u.•emrt meteRa4^are PSS'wss'�'�'.P--'-9".—ried and l.h .and'are a: <br /> 00 NOT-WRITE I'.AREA a=teW <br /> INVOICE# AMOUNT$ i INVOICE# I AMOUNT$ �,�ea, oa�oa�momxaPaemce rou� ad�eo�'^^pMcrTa�c«asPn <br /> MANIFEST CODE SEQ# <br /> EDI7• y - { ` ..E�s C t S t% ti 00to45 9-29 <br /> -� <br /> Print Cuab*er Name T . <br /> -. - EXP.DATE T i e <br /> CREDIT` QCT AMEX r—r-f-- —I 1 <br /> i ( VISA �/ 4 ? <br /> I l b - <br /> ii MC I B�Customers Authorized Represeniattve <br /> ER REFERENCE I I <br /> :o I •• .0 T's-tiG AC;RFI=MENT CONTINUES ON THE REVERSE SIDE <br />