COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

� 1 DUNS NO. 05-397-6551 FED.ID NO. 396090019 _s.. +_ :3. :. 2600 North Central Expressway,Suite 200 800-669-5740 yscrveouLED SCHEDULED Richardson,TX 75060 w .safety-kleen.com `"- /�' FOR SERVICE CALL BRANCH MANAGER DOC.EXP. SERVICE wEEK TERRIoav INIM $E, CUSTOMER NO. I VI Orn�iJ 7�� L 0 v 1 CREDIT PREVIOUS BALANCE ( v W CODE V D C U �jfj/��A. (/ /'� 5 L i F h i g C� UBTMENOME CHAIN DUTIES SVC P/C PROD.PIC F •�1 A n 1 ,n SEGMENT COUNT' M3fP ( �Q�V"`e l E • LOCATION TAX EXEMPTION NO. j to)Ao' iA , g5ab SERVICE DATE SALES REP N0. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EOPT/PROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX O REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE c7. INV. PROMO SDS SERVICE/ CC SERVICE TERM scx.pIT GNEN DEPT PRODUCT UNIT PRICE DUAN. CHARGE TAX CHARGE MIN 'L ^`"E'O �°n SK OOT TERM r s a;rI.LL : CODE N0. 3 0 3• o 2 0 83 7 ❑ El4 C '-tS a 1 2 ❑ 'I 5 ❑ 1 6 ❑ 7 ❑ 6 JE 910 11 12 �No �q CHECK GOOD DDR YES NO F TOTAL-SERVICE/PRODUCTS ✓�`� ��" pecALslN PucE MACHWEPROPERLY GROUNDED rn- APPROPRIATE MACHINE WNOITIpN ANDLEGIBLE LOCAL PHONE NO.STICKER Z A BOXES &CLEANLINESS FUSIBLE LINK AFFIXED TO MACHINE ❑ W INSTALLED USEPA TRANSPORTER 1 ID NO, USEPA TRANSPORTER 21D NO. GENERATOR USEPA ID NO. GENE RAT OR STATE ID NO. LAMP ASSEMBLY ❑ EMERGENCYCLOSINGSPENT SOLVENT MEETS �❑ CONDMON OF UO UNOBSTRUCTED ❑ ACCEPTANCE CRITERIA 12.CONTAINERS 13. TOTAL 11.UNI CERTIFY THAT MY TOTAL 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME,HAZARD CLASS,AND ID.) N TYP ANTITY WT L SK OOT NUMBER WASTE STREAMS ARE WITHIN W ,YAJ1 (/^ �/ � r.1 ��{� (� U//��2 ONE OF THE FOLLOWINGCATEGORIES J A. Af �K��Cy�V v� l�/Q C ` C� { l `^ ' j I V4 OTO 20 HS.IMOMH sZ Jd //•1 y$/(L�jA.�� 7F(' 7adb /IE �} /1E{^�l 1�/.Y�/11I�!j (�(� wIT— Y B. �l S \ -/ 1G V I rlT v'�VR/ O V'� i 1 220 BSJq 2,W BSAMONTH Q INITIALS CIO C GREATER MAN 2 J,200 LBSAMONTH z ^> INIIALS D Q N $ NATED F CILITY NAME AND ADDRESS ' I CERTIFY THAT No MATERIAL CHANGE HAS OCCURRED USA EPA ID NO. Z DES �� ^L.` EITHER IN THE THE PROCESS OF THE WASTE a VA c 6 ,L �� ( . . A� PJ ll. MATERIALS RF IN THE PROCESS GENERATNG THE STATE ID NO. W K K JlCJ�1T Wr r�(� V WASTE MAI£RIALB. TOTAL RECEIVED APPLY PAYMENT TO: MAN FEST NO. AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE O CASH ❑ CONDITIONS SET PORI ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) �J m CHECK NUMBER ❑TODAYS SERVICE/SALE PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE Waa INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDNIDIIAL SUCKING THIS WASTE MIN. ❑ PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) wmN nrn mo aoo..aa,aae reN.naa aro woPare ao�e.a.roaxwoa„rerxm ora wane,ora are m INVOICE# AMOUNTS INVOICE# AMOUNT$ orePormaamon nrn.a.Porulloa.onre aaNrl,oePdlonle r.Puunoa.aub wammemmT roon.rm.' TOTAL DUE MANIFEST CODE SEC# /'• �n , ��, N I 'Ji'ril aTHLAHFA LL PREVIOUS .__. .... ___. __.._. _.._ • <T' „ A CREDIT y Print Customer Name 1 1� RD � i1NJ Q—� ISI AMEX I "'1I � _ I l JJJ VISA IN THE EVENT F AN MC EMER e • r• B •F By:Oust Authorized elan tative CUSTOMER REFERENCE :FF • T H I$AGREEMENT.,JN IIVUE60P -uE HF4FPi- INFORMATION —r_ -- -----17=11=1- -