|
SERVICE ORDER .
<br /> FOR SERVICE;CALL:
<br /> ARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM No.WDI 5flQA D (1/1i)
<br /> � 4J$.02d0'
<br /> A. � SERVICE,QRDER NO:
<br /> FOR.ACGC1tlIV7INGLL: _ N2631408
<br /> 562-2314550 1
<br /> ENVIRO.N,MEN'TAL SERVICES,.
<br /> H STOGKTON'DODGE INC ` 14287 EAST MANNING AVE,PARL•IER CA 93648
<br /> P M3 AUTO CENTER CIRCLE t.5S9�1�a azno PO.BOX 80M ;
<br /> p WWNl.WORLDOILCORRCOM
<br /> E
<br /> STOPKFON;CA 55212 TRANSPORTER EPA ik CA7628277bj6- ' STO'CKTON, CA 95208
<br /> ° (205) +4.77-388$ 4209)477-3808
<br /> CUSTOMER# PURcHASEORD.ER,# ROUTE_#..I TRUCK-# CONTACT NAME ORDER TAKEN BY HALIDES }
<br /> ST0627 ER�B C�t.t{, CASEY aI+/elazgt,exx
<br /> DATE REQUIRED BATE ENTERED NEXT 5ERVICE DATE . C6s"I'014 of EPA# BILL o('LAr1lN&MAN1FEST1`'','
<br /> 71�1�; . • ,' •.. •. ... �,_ CAC3g8�5e7�8[t � .l �.(�� �-b.�� '`�,�{,
<br /> PART}y DESCRIPTION': OTY- -UNIT PRICE. CITY PIU,. TOTAL
<br /> OIL SO OILY SOUDM:70i DRUM
<br /> 55.OfrM 55 GALLON OIC;DRUM(RECON0MONE01... ,-,.. 1• 352,00'., 4 M.66
<br /> EMS EMANIFESf'EPA PEE&•ADMIN--=:SITE SPECIFIC MANIFEST 1 4%00: $10.00
<br /> '�. .i u••'i ..•.u: .• .i rslat�i:Fl -,n:.,r_•;}i_•r�,idJ. .. . . .- - a
<br /> BATCtI.
<br /> IErte ;71 f2pt�, rvics bkgi�, '#, p 152
<br /> U8 and A
<br /> CASH RECiT]'• :CKCK.#a Gi !'.
<br /> . .. •'CSA 'E+('ORMArION',
<br /> ,.. "ri�i .' •� . :>.. ,I,.t - ... �,VYA�t>:•U~<5P''.' L l l= ,. .-�. ..,. 'i. .. .. . ,
<br /> NON-RCRA.HAZARDOUS WASTE,LI,QUID'(USED 16IUMIXE.0115) ': STATE CODE 211
<br /> NON,RCRA-HAZARDOUS WASTE.LIQUID:(ETM(LENE.5LY4;0L'SOLu11QN§j. -'. STATE'CODE
<br /> Ci7H ER:
<br /> `t?ESIGNATEDT'ST)F:
<br /> ALTERNATE TSD F: -
<br /> 5 15 CG I31 it Pd 4 i C.t�� ktam��.r�Tai*LAuiR -—
<br /> f]RUIV15 PIsJ: EMgTY.DRlJMS: fAC1L1IrYt'' BSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK.THE APPROPRIATE BOX)
<br /> By,I(Inln9 below I hereby certify th)u
<br /> ,I
<br /> (Waste oil generatorlcu5t(jmer MUST check ONE ofthe-following three boxes)
<br /> =31111 have not tnlxcd any of ihr,w.l:ic dc:rabid aLkwi 5vltt lin]Wirer hor�sdolis waurr iii faeej hal dv iorStcnt it iE55illan i,ilW pprri Ana thu w.uv dors Iii l cu Ill din dh R(�it;hive[pnifilrod with lilt}�ihilirrfiiri i�bf
<br /> the applicable Callfomia used oil managen,cnt re9uhdoni to dpletmine this li trur,I a9W to acfl!Ptelte adlRtlon4l charrgsfor Lhu dlspas.d of Ihls waste IIIhe Inhalmarion I flare 0ayidedAtm Ids waste jslritilrteet:
<br /> ,•l
<br /> M:1I hwu tell nslrrrl any of the waste timnlhedpbow with any closer harm douswaist.the W;it hAde cohlent isWCATER Ibbs I,000ppin,aril the wage 4oes not ear t3in any f'Ces.i '' •"
<br /> hast!prvridid perpre slacyrrlrnW lisn�to lWoM oiI Erri Rqr�Y11A!5NyleC'�!n reBut L�jC pt+dump,Jian Ih.'tt tflh wa tt'"s miKvd wuh other haxardaus waste.I aMrr to accept the acldilku l chgglutfor tfie tl"sal,of this,: -
<br /> wa+sc tf 1hr Itifutrt+atl<+n.l havi provliH.`d aliput iliit'wasltElsZil�[Iarrrcl.,. rr r-:1:, i+ ..i•�•. ., ,
<br /> t�E3]i7lif lYasllif f-i-y11m:l1.!•tk as}ilil5(unr[.S WafSC>.14 lypin hb11SC110�d�rf0•t-y�t1tSCll•1plY��.}hdlDr[9nillill^htlllVy�rrenillt tlnal l�llxnlny rKetCl.11G!(«i�.r.�17ahIGr7.YG firs flp}Tkf lM1ykMlWt§[�r.thr'GRIywdLIP CIl EOR1aUM� •
<br /> in MyrjiY/a%CjGsMlieuirlrl Id,tll 15 snleyf(um DIY•lrwV&CUIQG fuui�m I/Ialm nbt thiseJ Wl1L d JIIlhIIll any olhtr hubrdout Wave of waiw nil rtpnl.1 ho%6ume.�-fagfe,%o jx c of lie addurcrol ch.sagpslbrdlc*al
<br /> of this W.1%It 11 lho nl fnrrnalkin I hwe ruov pied aha tri thlt w.)11e 11•IrxtIFnXI. '4' " '"Ir
<br /> (All generators/customers MUST read the following text and check the assoclated box.)
<br /> LJadj It l.,ns a Muir.ryuanl ly F�L•nelalCr,irMxffy that'}IsM a pfogeafn In plLkv I17+edixe the vokimo anti tW ISIty ul waste Voerned to Thr cfpgrcc I ha%v dell'rduned to be cmDaptiolty prauAcC a arw I•hat i lTxm
<br /> urrcrtd the Wxtic ablr lilt thou of Irratmenr,s10ra9"r disposal clifrently"Allibld to nse which Itanl,nlrvs the pre sr n arid futlr+c Sheryl lu t/ fILl l lift arv!Ibe r iittllsnienl;Ur if I and a vase gvarmIq 91'fletoar.!!"
<br /> I+mr mule a e3nwl fila,rrllolt tv Inlnhnite rm WiRr+Jennaftt- -All crd b[Y 164 bell WWa L T"AROCLje rPpnt rrleihud 11,at Is'nc:r Walk.Io not IVA I can afriof& I
<br /> 'flys lndlvnlual xlrjrvrsry hS Ilse spus•wt 1w lh Iwkry at behalf oI Customer MIRMU u and was rano sluT hrri}lr has 1111 Iuthorlty lu Fit lid Cuavnst:f•lhw tilt forgo frigdt:cil plsons of waste an4 rnatrrfals sen Int.and aOCU*lr
<br /> a lszO ujnl.ma M-rkd labolcd,ata.malty for Irjn:por Wlims in accue daric r with ai}plkafalo i1 PTe ami fcdisral rcgt"iti .and tll.,I Cuvultltlf•.hill ah1t r aMl by bourW by fife Wlislahl Tvrslss and Coeuhnons nn the P"I:fw
<br /> side of l h l:Ser WtPCjr+lrr. s
<br /> Clash�wte Dale Drivee5ignitl N� Date'
<br /> � d Ail
<br /> r: ' o
<br /> Print Name Print Drivers Name
<br />
|