|
0 ' v 113
<br /> FO E;SERVICCAL� SERVICE ORDEf#
<br /> ���1 ,'•• '
<br /> ,, AVAR ER + ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WO,E5004 D (1/17)
<br /> 5R49'8-0240SERVICE ORDER.NO.'
<br /> y
<br /> ,FOR ACCOUNTING CALL
<br /> 562.231-155&1 NL'�: . l,fir N=14110
<br /> WORLD OIL '.'
<br /> ENVIRONMENTAL SERVICES,--,
<br /> H- STOCKTON,DODGE INC-- W287 EAST MANNING AVE,PARUER CA 93648,
<br /> 11-559 498.62.4,?
<br /> P �AUTO CENTER CIRCLE V r. ii PO.BOX 800®:
<br /> E WINW.W& -OIL-CORP,CONF'
<br /> STOOCKTON._PA 95212 'TR IVSPORT0-�PA:#CAD02f 27706 *S
<br /> 3TOCKTOR CA'95
<br /> 0
<br /> 477-3M{269)477-3 (2(3$]4-n-4 8
<br /> CU;STOMEk#k PURCHASE ORDERA ROUTE A..' TRUCK.9 CONTACT NAME ORDER TAKEN BY HALIDES
<br /> ST062 ER-88 CASEY aveWouiax
<br /> !DATE REQUIRED DATE ENTERED =' NErr SERVICE DATE CUSTOMEREO/ A 81LL'd7FLAD1NG/MANiFE$T A`
<br /> PFIRT k DESCRIPTION! QTY �UNIT.PRI"r QTYPIU, TOTAL
<br /> OF USED hlET►AL OIL ANp GASOI.JNF.FILTER$ ,.; ,a.,,,.,•,� '�,..-,, p `35aoio `��, 00.00
<br /> OF-OR ' CIL FILTER DfRPM REPLACI MSNT-NO CHARGE' 2 0,00 $0.00
<br /> Emd EMANIFEST EPA FEE&ADMIN-CC3NSOl�II MED MANIFEG 1 $4.00 $4,06-
<br /> • .1.' .�
<br /> c
<br /> EPA Fo
<br /> �tre�71 r�a1B Servlaa ortkls vvfdl'� > tikesM rliAt+KI3et* ire aft o. - eps vovar PA paste'
<br /> R+e dadrrllnk# llasl.'afithe e�lilF>aat „r, eea itnhl.S4. l.fi�tisi:3R'� e. glkila fees &soh ur I'tvdirxa
<br /> CA5H RECD�
<br /> :. WASTE-N3 PGSf�L INF.LTRMATION;:.,:.. .
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED L]IIaMIXEG7'C}iL5} ': ► STMT COOE•22I
<br /> }OWRCRA HAZARDOUS WASTE,�,IQUID(ET1-1,YL£NE GLYCOL SOLUTIONS}, STATE CODE
<br /> :'gTNER: 1�E�1JW9AHA7,�B1 �� 11i} iL7 �71�A3�11�4!!.»� S D 2M--,--.--- -
<br /> DESiC;NATEpTSDF:' YUMA YE,9 LLO,27311E Ll 13' ST-YUMAl AZ fi'r 5j192&RW28Q3
<br /> ALTERNATETSDFi — _
<br /> �rl1Sg►�LktBI L �91�[1�ti1Llk CL S7j[' — A�Coil,
<br /> TV
<br /> T,
<br /> DRUk.MS P/U:Lx EMP.TY.DRUNy15: FACILITY:
<br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE.BOX)'
<br /> .Sy,3lgnitpdiaelssw{I+ d7X;i:vnflythat: -
<br /> r h ` (Vllaste ail geinE ratorl;rusiorner MUST rIieck ONE of the Following three boxes) '
<br /> C'fIl)1hiwrloirftlawory'ul1hewasedcscribcdpbo'rewith unyviiier1s33;1ri1vuswane,lllr1Gi)tI+,11IJriivs,ttrit:sLt:55than'I;gpUppn,;ander.ewaifirdpi;fotconstuiahi-Ki,Ih4y t.�irriplfudwlih:Uiaryl�yidvfilgnliof
<br /> jlyt alilflkt%bleCaltltanla.usszl UI management rcgulzOlin to d7tcerainr this is true-I agrry to attrpt the addiUonat chaiges for rhe dispoaAf or ihltiwa1h:KILN Information I hw%t p.WV*d abotd this waste i,ori ilea `
<br /> M12 honk N1 mh rdany of rhA waste dcserilx6l 444wc vath atryal1w hataWoul Wyste,UIQ local halkleconlent liCiSrA7 CA Ilan 1,000 ppm,and the waste docs noi.conlakt any,PUS.I
<br /> hen+stptt{v}detl prnpw amummtolgn to woddol rrr kpnrnmlAt Se cq to svbyt ll?e prti l pljwr than this waslc was n lxcd with oftr ha:ardoyswaslt-I agree 1p Af'"1pieat dmanal cha,9cs for,the disposal nl,his l +
<br /> - wysSe(��hdlnEvnslaUvn_IhanjxcwWrdrrboutlf,}pwaS,rlilncurra¢f�..� ... .,, .
<br /> M031Thii wa;Te 15,40m a.tanitwhrch callttlI wear tia from hoof, cJd'db•f1.7'o4ne1S-U*)raidPotcoro11otsally v+tetn�A 111%,10 ftrldnllry grnrreptar ICESgGI lnuteei,To the'bcst of�rrvy kno.'vleelp.lhaaMywAsty olleontttirtrral.
<br /> Ili nii C1tVICLSQG.salltclfan Lusk 11 wlry.rnnn Dly anwor CESM suutkdl.I.1l wt rfdrniumdill i,vastval!WAh any od+krhz:Afduti%was!^dr eehtle oil ham aUsce toke:L I)arca:to Mtrpl Iheadditional dyirylCf`ferdypdWl
<br /> or 116s wa„v R the ialarmlllon I have tnavlrted atio+,t Ih1%wastr itIneorr ct
<br /> s
<br /> (All generatorV customers MUST read the following text and Check the associated box) •, ' •'At
<br /> E=ta)if d"a,Ivgr qu;ent ity penr+alor.I tat my 1hM I hart a PH41tarn in place to teduce the Vol umr and raFkq of wale genemso to lire degree I have de term fried to ht esanpmi[aRy pr,7ttkahly aryl that 1 hive
<br /> srloetwlm pnetica¢1v mrlhasl of Tfc:llPiero.storage.at dlspesolcul+rn,iya+)ilyWv tri me whlclt',nintmltr;il,v pretrrlI anis fulcra tlut0t,Io h1ln,4n Ildt and Sht efthdijmtnl; Leer,asrnall'guintrty gan Vidor.t•
<br /> hxry made n'guotd faith clfart to tnlnimn.0 my wa itc W00;I ikm and%cleft the bat wallC nh4is7 nement moi hzA I!%at h avarlahle ro me 1h.1I441arfatll.
<br /> This Individual signing in the.sp3ce set forth holmv on behalf of Customer reprei6nts and warrantslhot he/she has theasdhurky to bind Customer,that dee rd7goi,til dmet+pnnm o[w.)sr4 art<I ritau als are true and accUraie
<br /> as packaged;marked and labelal,a,t Beady fnr tramp.,tmi+ni In accordance wlth applicable state,and federal regulapans,and that Cuslornce shall abide and liehaund b Ilse 5landard Tefrnn and Conditions on the reverse
<br /> sidn.of tof'thk Service Order,
<br /> Cus nee Signature _. Date Driver Sig toe ' Date`' '
<br /> �— — - — —
<br /> Print Name r Print Drivers Name
<br />
|