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2600 North Central Expressway,Suite 200 800-669-5740 DUNS NO. 05397-6551 FED.ID NO. 396090019 <br /> Richardson,TX 75080 www.safety-kleen com ,�--_`'. FOR SERVICE CALL BRANCH MANAGER DOC.EXP, SCHEDULED SCHEDULED <br /> n"011. CUSTOMER NO. `-�_'` SERVICE WEEK TERRITORY <br /> If <br /> c 0`354`:;1.09. 1 Tot^r'E�s, F�'=R7.�3h 7,?.89760 s <br /> L 1 � 0 1 0 7 <br /> U CREDIT PREVIOUS BALANCE <br /> V I CODE <br /> LrfhiA �j{ocl<l� ✓iPl � e, Ki o. I'L� `f� <br /> C`�^ ` USTOME CHAIN OUTER SVC P/C PROD P/C <br /> / SEGMENT COUNTY <br /> M <br /> l; 1\\`/ <br /> !ER;Vlfr,EDP,TE VI . 0(5;U21 a <br /> LOCATION TAX EXEMPTION NO. <br /> T �U LO ,o, .- <br /> SALES REP N0. CUSTOMER P.O.NUMBER I CUSTOMER PHONE OF TAX CODE DATE EOPT/PROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX <br /> DEPT SERVICE/ REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE CRµGE <br /> PRODUCT UNIT PRICE DUAN. =CHARGE CHARGE MIN. CLLAN srrN- DF CC TERM SERVICETEPM scx PATE INV. PROMO SDS <br /> 1 OcT.0744 cia'] . SK DOT , VICET l,M ,� CODE NO RIVEN <br /> 2rJ , l ❑ <br /> 3 3O ❑ <br /> q ❑ <br /> 5 ❑ <br /> 6 ❑ <br /> 7 ❑ <br /> 8 ❑ <br /> 9 ❑ <br /> 10 ❑ <br /> 11 ❑ <br /> 12 ❑ <br /> TOTAL-SERVICE/PRODUCTS 39� CHECK Goo] P00A res NO ves NO <br /> / APPgOPPIATE DECALS LEGIBLE ❑ ❑ MACHINE PROPERLY GROUNDED F <br /> BOXES MACHINE CONDITION ❑ ❑ AND LEGIBLE LOCAL PHONE No,SOONER ❑ ❑ <br /> / SOLPASESMBS FUSIBLELINK ❑ ❑ ❑ ❑ W <br /> USEPAr7TiANSPORTER 110 NO. USEPA TRANSPORTER 2ID NO. ..GENERATOR USEPA IDNO. GENERATOR STATE iD NO. AFFIXED TO MACHINE~ LAMP ASSEMBLY ❑ ❑ EMERGENCYCLOSING ❑ ❑ SPENT SOLVENT MEETS <br /> CONDITION OF LID UNOBSTRUCTED ACCEPTANCE CRITERIA ❑ ❑ uP <br /> 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) 12.CONTAINERS 1B. TOTAL 1A.urvlT SK DOT NUMBED CERTIFY THAT My TOTAL <br /> NO. TYPE DUANTITY WT OL WASTE STREAMS ARE WITHIN LU <br /> /� ' ONE OF THE FOLLOWING <br /> A. O } IQ L,? &Aamvul1/��A ✓� Iq1 CATEGORIES. 3 <br /> \ J`\A O TO 220 LBSJMONTH O <br /> tAH0B �Ze1- Z <br /> . �� (d� 6 �l l ' (U�c' o 014,^4 221 Les.ro INITIALS <br /> LasJMONTH Q <br /> C. U) <br /> LU E <br /> GREATER THAN 2,200 LBS/MONTH <br /> Q� <br /> DINITIALS Q✓V <br /> DESIGNATED FACILITY NAME AND ADDRESS CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED <br /> USA EPA ID NO.&et Z" <br /> EITHER IN THE CHARACTERISTICS OF THE WASTE /N <br /> MATERIALS OR IN THE PROCESS GENERATING THE LJ \ <br /> WASTE MATERIALS. STATE ID NO. W <br /> 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 Uo <br /> CHECK NUMBER CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT (FROM ABOVE) <br /> ❑TODAY'SSERVIGE/SALE PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE <br /> ❑PREVIOUS BALANCE AS FOLLOWSINDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS WASTE MIN. W d <br /> LER MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) Lu <br /> INVOICE# AMOUNTS INVOICE# AMOUNTS w=xagw,—Me.nehoeLI <br /> Phoo—mmonrorvebPox+I n.=o,aNa m me alle.m.hK.I.tia,.of the mrenmem olnenmo�elmn` TOTAL DUE <br /> P IOUS MANIFEST CODE SEC# / <br /> CA DIT _.._. L.� I.A -l.r. <br /> l iNf .I I' <br /> C L� <br /> AMEX <br /> —I rini ustomar <br /> A '� <br /> VISAIN THE EVENT OF AN <br /> M EMERGENCY CALLBy <br /> CUSTOMER REFERENCE Cu mer' uth ietl Re reseniailve /W <br /> INFORMATION "' 1760 THIS AG _EMENI CONTINL S ON THi-I -RSL SLD!' <br />