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8 1301 Gervais Street - Suite 300 �.t'M 05 3o»65t DUNS NO.SCHEDULED FED. ID NO. 396oeoDte vvv r v�•r►_.. Columbia, South Carolina 28201 '�y�' FOR SERVICE CALL BRANCH MANAGER DOC. EXP. nY CUSTOMER NO. 1909—F,49-10111 M00176 CHECK GOOD POOR YES DECALS IN PLACE ❑ MP TE M&"E CONDITION ❑ ❑ AND LEGIBLE NO YES ❑ MACHINE PROPERLY GROUNDED ❑ LOCAL PHONE NO. STICKER % % --7 . 8 CLEANLWESS FUSIBLE LINK ❑ ❑ AFFIXED TO MACHINE CREDrt PREVIOUS BALANCE CODE C LIMP ASSEMBLY INSTALLED ❑ ❑ EMERGENCY CLOSING ❑ /) i/^ / ' ` 000050930 0 CONDITION OF LID UNOBSTRUCTED U 1 11. US DOT DESCRIPTION (INCLUDING Gv�PROOPER SHIPPING NAME, HAZARD CLASS, AND ID.) 12. CON AINERS TV 13. TOTAL ATI s T SK DOT NUMBER i -1 BUSINESS OUTER CHAIN COUNTY SVC. P/C 7 � 1 l` �. Ik'IV1 .l /ry rl'J �[.: C �(f1 r f� U L] % 1 �� f� J �% i _L /v '' , .1 '/ /NO �.:'..; V J fJ ; - M / 1t. { L/ /-': SJ • ONE OF THE FOLLI OT0220LIBS./MONTH LOCATION TAX EXEMPTION ,yam hl`1 1 SERVICE.DATE SALES CUSTOMER P.O. NUMBER CUSTOMER PHONE # TAX CODE HANDLING CO DE CODEDE. SERVICE TAX C.O.M.S. TAX PRODUCT CO J'V ! SERVICE/ - E R IAL R laif� S SALES TOTAL WASTE SOLVENT/DRUMS CC SERVICE SECHANGE SCKDATE wv. PROMO DEPT PRODUCT 1.,•I I I I p DUAN. CHARGE TAX CHARGE. MIN. .LEAN SPENT SK DOT TERM .Y;'E,; 1I4110 CODE NO. 1 t �> >ii`� ,''✓ - ...r;a � i,:) lti U c..1 �/'•j 4 i✓�.i 2 �'-' ) �,. ,.-- a - —— INITIALS ' c. 5 GREATER THAN 2.200 LBSIM 8 10 11 12 TOTAL-SERVICE/PRODUCTS /y - ` } j4/ „ , T CHECK GOOD POOR YES DECALS IN PLACE ❑ MP TE M&"E CONDITION ❑ ❑ AND LEGIBLE NO YES ❑ MACHINE PROPERLY GROUNDED ❑ LOCAL PHONE NO. STICKER / . 8 CLEANLWESS FUSIBLE LINK ❑ ❑ AFFIXED TO MACHINE ,w ANSPORTER I ID.NO• CISEPATRANSOQRTER ` l' `,` - _A'I4 NQ:" ' • 'GEN RATOR STATE ID NQ,-" LIMP ASSEMBLY INSTALLED ❑ ❑ EMERGENCY CLOSING ❑ SPENT SOLVENT MEETS ❑ C ' ` 000050930 0 CONDITION OF LID UNOBSTRUCTED ACCEPTANCE CRITERIA ' 1 11. US DOT DESCRIPTION (INCLUDING Gv�PROOPER SHIPPING NAME, HAZARD CLASS, AND ID.) 12. CON AINERS TV 13. TOTAL ATI 14. UNIT SK DOT NUMBER i -1 I ERTIFY THAT MY WASTE STREAMS ARE V 7 � 1 l` �. Ik'IV1 .l /ry rl'J �[.: C �(f1 r f� U L] % 1 �� f� J �% i _L /v '' , .1 '/ /NO �.:'..; V J fJ ; - / �.. �^ ONE OF THE FOLLI OT0220LIBS./MONTH ,yam hl`1 1 J'V ! INITIALS B. y r�%' 33 220 LBS. To 213/10 /r. �,. ,.-- —— INITIALS ' c. GREATER THAN 2.200 LBSIM D NITWLS DESIGNATED FACILITY NAME AND ADDRESS ;; Al E TY — K. L E E N S' Y :� T E ! l a , I HC . I CERTIFY THAT NO MATERIAL CHANGE HAS OCCURRED EITHER IN THE CHARACTERISTICS OF THE WASTE USA EPA ID NO. �- MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. WASTE MATERIALS. TOTAL CHARGE t CASH El TOTAL RECEIVED APPLY PAYMENT TO: I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TIONS SET FORTHON REVERSE OF THIS DOCUMENT. (FROM ABOVE) CHECK NUMBER ❑ TODAY'S SERVICFISALE i LX -J PLEASECHARGE MY ACCOUNT�FOR THISD TRANSACTION UNLESS OTHERWISE WASTE MIN. ❑ PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE INDICATED IN THE PAYMENT RECEIVED SECTION. THE INDIVIDUAL SIGNING THIS DOCUMENT S DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITS TERMS. (FROM ABOVE) INVOICE # AMOUNT $ INVOICE # AMOUNT $ -nn W b cw* MO IM ab—W� mW" wo p p" CI—ikd. paaagW. , Md W WWW. aovr �� w. vanpaNlon acwaq W uw appllcaole repl,I.oaW a ur oapumW+a Traaaconawn • TOTAL DUE i T O MANIFEST CODE SECT # ( / c D•n c.`1r114.11RII RE.� 7 . T e'!w Print Customer Name CREDIT CARD NO. AMEX ( EV. DATE VISA • y j 1�1i� M00171164'178 I I I I I l.�i i7'' 1 ® 1Cr.1'II