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SCHEDULED SCHEDULE <br /> BRANCH MANAGER DOC.EXP. SERVICE WEEK TERRITORY <br /> Plano,Texas 75024 www.safety-kleen.com FOR SERVICE CALL <br /> 11111. CUSTOMER NO. <br /> r5 <br /> C CREDIT <br /> CODE PREVIOUS BALANCE <br /> V 60 i, 'yT <br /> J 4 <br /> l CUTE <br /> T "4 CUSTOMER <br /> j .P/C PRO <br /> SEGMENT <br /> COUN <br /> CHAIN SVC P/C <br /> 0 <br /> M <br /> E a LOCATION TAX EXEMPTION NO. <br /> R <br /> SERVICE DATE jSAIE$,f1EP No. I CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EQPT/PROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX <br /> DEPT SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DR cc SERVICE CHANGE CW INV PROMO MSDI <br /> PRODUCT UNIT PRICE <br /> DUAN. CHARGE -- —77 TERM SERVICIETERM SCH.DATE <br /> —TSIENTI ANN T <br /> TOTAL <br /> MIN. CLEAN Vs E NO. <br /> TAX Sw –OT JWEEKS(INITIAL) (yy COD GIVD <br /> w.5 ?j -7 4 <br /> c <br /> 17--7 4 =�'l <br /> 7'� <br /> 2 777. El <br /> ......... <br /> 3 1 '�J t" El <br /> 7� <br /> 'FDATE <br /> -7 <br /> 4 77 7—, --7-777-1 1 /1 f-1 <br /> F , <br /> -77 7 7T 3, �7 <br /> 7—7 -------T..................... .................. <br /> se <br /> 5 <br /> 6 <br /> AN <br /> 7 r- <br /> 13 ❑ <br /> 9 <br /> 0 <br /> 1 El <br /> 2 El <br /> CHECK GOOD POOR YES NO YES NO <br /> TOTAL-SERVICE/PRODUCTS DECALS IN PLACE ❑ MACHINE PROPERLY GROUNDED <br /> APP PPItATE MACHINE CONDITION AND LEGIBLE 0 1:1 <br /> BOXES &CLEANLINESS [j E] LOCAL PHONE NO.STICKER Z <br /> FUSIBLE LINK <br /> gw —+ AFFIXED TO MACHINE <br /> . ........ LAMP <br /> ASSEMBLY INSTALLED w <br /> F-1 EMERGENCY CLOSING SPENT SOLVENT MEETS <br /> CONDITION ❑ 2 <br /> OF LID UNOBSTRUCTED ACCEPTANCE CRITERIA El 0 <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12.CONTAINERS 13. TOTAL 14.UNIT <br /> ' NO. TYPE QUANTITY VVTNOL SK DOT NUMBER I CERTIFY THAT MY <br /> I w <br /> WASTE STREAMS ARE WITHIN <br /> �v 777= j <br /> ONE OF THE FOLLOWING <br /> SPCATEGORIES. <br /> 0 TO 220 LBS/MONTH <br /> 0 <br /> Z <br /> tA'L L) <br /> 220 LBS.TO 2,200 LBSJMdW < <br /> INITIALS (D <br /> W <br /> GREATER THAN 2,200 LBS./MONTH <br /> DESIGNATED FACILITY NAME AND ADDRESS INITIALS <br /> 1 CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED Z <br /> EITHER IN THE,CHARACTERISTICS OF THE WASTE USA EPA ID NO <br /> MATERIALS OR N THE PROCESS GENERATING THE STATE ID NO. <br /> WASTE MATERIALS. w <br /> CASH TOTAL RECEIVED APPLY PAYMENT TO: yt <br /> AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE C <br /> CHECK NUMBER COND T FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) 5;F <br /> ❑TODAY'S SERVICE/SALE rrIONS SE <br /> Z2' , ;,) / - PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br /> ❑ PREVIOUS BALANCE AS FOLLOWS Ibm KA'r:( INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. <br /> MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) LLI a <br /> INVOICE# <br /> AMOUNT$ INVOICE# AMOUNT$ 'This is to caddy that the ab—named namenals are properly cassffied,packaged,marked and labeled.and ane in <br /> PrT'!.�Vflon for tmmpDfttion acccading to the applicable aguieffions of the Department of Transportation' TOTAL DUE <br /> ,�TAL <br /> .IN <br /> N. <br /> —LL <br /> PREVIOUS ................ <br /> CREDIT0 MANIFEST CODE SED# -"I DO NOT WRITE HE AREA BELOW <br /> -CARD N <br /> ----------------------- Print Customer Name <br /> Wyl <br /> By <br /> USTQMER REFERENCE Custombes Authorized qdpresentative <br /> INFORMATION THIS AGREEMENT CONTINUES ON THE REVERSE SIDE <br />