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Sea-12-10 10:54 From-DK Dixon/AES -- 17076782339 T-046 P.005/013 F-094 <br /> .-800-7-ASBUR Y � N ti f l�i 69'S <br /> a <br /> UNION CITY OFFICE r� <br /> r-Baa-803-a644 <br /> Ili ASHURY ENVIRONMENTAL.SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON.CA 90221 <br /> 1-310-B66-3400 <br /> -, TRANSPORTER EPA#CAD028277036 111Wj WLST EDIBUN <br /> P <br /> HANTk7CA l'IRE <br /> E .?U1 W6SS7 E.lilSUhd - <br /> FI AI•Il l'.C:AY CA <br /> 0 <br /> !419) <br /> GA v`i$ <br /> o :Sci c� <br /> FIAId'I EC.r1" HALIDES <br /> -�3q `i`t`rLI ROUTE TRUCK# CONTACT NAME ORDER TAKEN BY <br /> CUSTOMER# PURCHASE ORDER# R <br /> 9,yMANIFESY# <br /> 6"1 NEXTSERMCE DATE CUSTOMER EPA <br /> DgTE rtEQUIRED DATE ENTERED <br /> CAL.Q10 VN07.E17;'.40 <br /> 7 �'?NN4 UNIT OYY PN <br /> T TAL <br /> 77 / QTV <br /> � . <br /> PART# DESCRIPTION -� 4;':41. V•U - ti`;Q6..0 <br /> CIF" <br /> (I,;1_i> 01'.. AVID I;AsoL.TN£ FYL.TFk t <br /> I <br /> I <br /> I <br /> PLI-A <br /> TOTAL C U• . <br /> Str"P <br /> PLEASE PAY FROM THIS SERVICE ORDER <br /> CASH RECCHECK#D: WASTE DISPOSAL INFORMATION STATE CODE 221 <br /> I <br /> iNON-RCRA HAZARDOUS WASTE,LIQUID(USED 01LIMIXED 01L51'NO PLACARDS REQUIR —� <br /> r NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLVTIONS)'NO PLACARDS REQUIRED' STATE CODE <br /> OTHER: <br /> I DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> CFR: 33210�(I/Pstern Avenue,Union GA 94507(510)487-9277 <br /> ion Clty, <br /> ' BSC <br /> FACILITY.- — <br /> EMPTY DRUMS: <br /> DRUMS PAIL <br /> GENERATDR WASTE CERTIFICATIO ucew°sur. <br /> PLEASE CHECK THE APPROPRIATE 13OXa Ionm m.n.panedm •.cwamew•Pp <br /> Thbr.locMllY dml No waste de•ulped.pvve hofeb, rly Ily im.pad,tlucdped.De°°•ped,medatl.na l•bel°d,entl l•In prDP°r° <br /> 'h•" following three boxes) <br /> and Imeul uPYlanenv.Br e1Bmn0 P•luw I•I•D nembv mnpv CUStonler MUST check ONE of tfie f 9 ,p•„ PCO..I h-- <br /> (waste oil generator/ B m^w•"e tlw.l.1 lwnd1.00"I el IN.was <br /> m.adb,ana cn•rpee <br /> O Mil l FevO not ml•etl any.'In e w.eu pe.erlPed above wlln enY°Pur Mautleur waste,Iia tool Ivntlo c°nwm b Lk991Nn l.ppd Ppr^, <br /> empll•owho mYI..0 aemer,lel IM a.Pn.•bre Gelllornb u.ed nti rrum B°mans lapW.tlon.led•tomin.IM.b tn•°.1 aprs•Iv.cuPr .ntl Ina weW poes nal conbin jnV pees. <br /> it me Int°enaI on 1 nave Pmrld.tl.Pout IM•wa•w L Incertect ID¢wpl me aadldon.l cM <br /> In°lebl h"'de.pntent b".ad WA MN°r naaDld u• weate.I.B..e <br /> EnvwanmenW 9ervlco to rebut Ine pr.WmpOon IML Int1 uveae we•mlaed Ynm° <br /> oyl l nay.nor ml.od.nf of mo w.•u dee"",afore won_v-In er.... ue...1., <br /> vld°e.bout lob w.•O i°'r ..act •pyrce•.T.Ine pe•1 or mY <br /> neva OYmid°°Proper dowmanladbn to p.PYry enol pen°/aor(GE9oG1 <br /> u ounalr'IP 1•n Inw na°.rdaw W.M.or <br /> lot m°dl•poey of tlda weaPll the lnlorm•tlon ln•r.pn' ly dlDY cendlllanellY e.emplem.119v Y <br /> I ubanheu01.I.0°• 9 <br /> Q v)1 T^'•^'seta le Irom°un•wmcn cDllvrn••.•°° Itletl.Peut mb wow 1•Inoen°dated box.)IFo°Nv waste oll cpnt°InaD In mY 01Y1 CE50C.OMSC110111anF b•°II o1 NIa w.M°1141re CE�Ilwr I nrve pier nut rrVaed rnu w..re Va w t anY <br /> FnDMedO° •ler dLP°•• check the assoC <br /> Ovate o11 Irom atnor•vvrc•" I•Dr°°•°•°••Ft pi0 adlPvntl conn MUs•read the following text and check <br /> to tM de0r.n I n... eelemaned w bo eco Ill.ona <br /> (All gen' I w•au e•n ...I.ne iww.mml t°n"". Ilse ono <br /> o .miry p•ne..mr,I c.nnv n.°t I^•"°•w•V.m In OI.I, u reduce(M Yo. anp Ivaldry° <br /> dl. .1 eurt°mh.Yell.bl°w rM welch minlmlYe Ins pn <br /> p eel If am•IprB pD Ben.reI old eal•d meNerwuN-m.n.pem•nl malnedlMt1••"dlape <br /> molly 9.ner.IM•I N.a male a 9"d mill,e0.n to mlNmlu mr waeu / <br /> precb <br /> If <br /> . and Inel I nere+uectaD tn°pr•mb•N.memos el tr..tmant •urea°'w I r r <br /> me ev...... t,O.111•m•emalrp <br /> tom°plat 1 cee eH°r0. II - 1--I �� ----'� pate <br /> Orivcr Sig- `Ura <br /> Date <br /> Customer Signa re ' <br /> 'I Print N2111e <br /> 8d 8ZLL-6£Z-60Z 1pueS uen /u06ea0 el,9:60 Ol b0 PO <br />