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2600 North Central Expressway,Suite 200 600-669-5740 DUNS NO,05-397-6551 FED.ID NO.396090019 Richardson,TX 75080 www.safety-kleen.ComT, FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SCHEDULED SCHEDULED 9pgg41g1p, CUSTOMER NO. as WEEK "ROPORY r"31ps35451iD11 Torres, Raiph `Z6g@Ql f7 11L 2 u D _ CREDIT l� �'T a p� CEDE PREVIOUS BALANCE BAL.OVER 60 DAYS U IGRZ.�. t1M�uNl. V1 Ct.S S _ ��N14 v�'� li � ��'i'S 1 Doc RrrrH RD t,t o -F��a�`I�1-I SEGMENT CHAIN � Nn SVC.P/C I PROD.P/C ��0� RAtN fft�co CA0410 an 4•'5.23 t-tow R�y.1 j CA�n �� / C60 6 SERVICE AAT[E ESA CUSTOMER L` TION TAX EXEMPTION NO. DATE r `OMMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EOPT(PROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX --m SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE C.IJGl SDS DEPT PRODUCT UNIT PRICE DUAN. CHARGE TAX CHARGE MIN ..Inv crl-r " SK DOT CC TERM SERVICETERM scH Dare GOOE P N0.0 GIVEN 1 4'3 So �- IVa• 1W. 00 ❑ 2 I [ 10. o.LS3 ❑ 3 ❑ 4 ❑ 5 ❑ 6 ❑ 7 ❑ 8 ❑ 9 ❑ 10 ❑ 111 ❑ 12 �y CHECK GOOD POOR DECALS IN PLAC YES NO MACHINE PROPERLY GROUNDED YES NO TOTAL-SERVICE/PRODUCTS D.7� ' �•g3 APPROPRIATE MACHINE CONDITION AN LEGIBL ///��❑ ❑ ❑ ❑ V BOXES gCLEANLINESS ❑ ❑ ❑ LOCA PHONE NO.STICKER ❑ Z FUST ELINK �!T'Ei W USEPA TRANSPORTER 1 1D N0. USEPA TRANSPORTER2 ID NO. GENERATOR UI ID NO. - GENERATOR STATE ID NO. ❑ I TALK a�yA�� CONDITION gy OIL UNDENDP TR SC 0 ❑ ACOEPTANCE CRNT SOLVENTITERDIETIA ❑ ❑ L 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12.CONTAINER$ 13. TOTAL 14.UNn SKDOTNUMBER I CERTIFY THAT MY TOTAL N _ TVPE UANTnY OL WASTE STREAMS ARE WITHIN WOU-ec oam V E•1 � ' �+O�/D ONE OF THE FOLLOWING A. Q le'D 1 V� L 11� � �OO /� T IA� 0t CATEGORIES. 0 `_ GTOA.'2.20 UONSn./MONTH Z INITIALS Y B. 220 LBS.TO 2,200 LBS./MONTH U C INITIALS W N GREATER THAN 2,200 LOS./MONTH J!7 D. INITIALS 0 ry DESIGNATED FACILITY NAME AND ADDRESS I CERTIF THAT NO MATERIAL CHANGE HAS OCCURRED1 USA EPA ID NO.�mU 60000 19 Z ry EITHER IN THE CHARACTERISTICS OF THE WASTE1kjQ n O V 1 V &j S OS 1�ls ATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. W ASTE MATCH— CASH ❑ TOTAL RECEIVED APPLY PAYMENTTO: MANIFEST NO. - I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE V CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. FROM ABOVE CHECK NUMBER TODAY'S SERVICE(SALE PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE ( ) ®•� >� Q INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WASTE MIN. Q Cc PREVIOUS BALANCERS FOLLOWS IMESSAGE UOCUMENTIS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) 51 INVOICE# AMOUNT$ INVOICE# AMOUNT$ `"°`°R °'"°"°'"°"'°'""'°"""P'°P°nr°I.'°"°°Pe°"°®e°mwkec a"a wealea,ena.re In Cn TOTAL DUE �{�B- 3 PREVIOUS _ MANIFESTCODE SEO# /' A ) CREDIT _... _... .__ SI `�� /30+°JA i'l IJ 1T WF iTTT I, r r r, IELCIV,1 QABD NO Prik Customer Name AMEX VISA IN 11TE EVENT OF' MCN —MERGENCY CALL /�/ 8y CUSTOMER REFERENCE Customers Authorized Representative INFORMATION -800-468-1760 THIS AGREHMENT CONTINUES ON THE R!"iFR';F SII