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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-6 (1/17) 1-800-1-ASBURY 'r�'U EiSU SERVICEORDERNO, FOR ACCOUNTING CALL: WODWO �J73g gg 562=23145.0- ." Aiz 125 . ENVIRONMENTAL SERVICES,. 5 STO3 KION btDGE INC 7300 CHEVRON WAY,DIXON CA 95020 . 333 AUTC]CENSER CIRCLE 1-a0tia- sauRY PC BOX 8009 p WWW.W0iif_D.0ILCO RP.WNl! " E. STf3GFCPON,CA 95 1 STC)CkTON;04.9520}8':. TRANSPORTER Ek 4CADb128277036 o (49)-477-secs (209)477-3698" CUSTOMER# PURCHASE ORDER.IR ROUTE# YRUCKP, CONTACT NAME ORDERTAKEN BY HALIDES. OW 124 SCHEDULED-i MIN L{s. DATE REQUIRED DATE ENTEREQ NExTSERVICE DATE CUSTOMER•EPA# 13ILLof.LAQ1N(;1MAWE5T# 6i3t�Y2Q17 6130/2017. CAD981967080014 �q PART•• ,'`:;: DESCRIPTION UNITPRICE QTYPJU.. TOTAL i] I X OILS. .0 $ WC3 G CJ5EO OI1M SERVICE CHARGE., 1'. $80.00 $80:E30 aAAt0+0 Streets- TOTAL. CASH RECD: CHECK•#— . WASTE DISPOSAL.INFQRIvIr 104 NON-RCRA HAZARDOUS WASTE,LIQUID(USED QIUMIxED'OILS)' STATE CODE 7.2'1 NON•RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE. QDE OTHER- DE5IGNAT,ED15€?F: ArSS)3i.AY ENVI}�Q Nk4ENTAL SERVICES•CERES,'. - – 1g7A 14101ti3Ar1'.RC3,,CERES,G4 3368g)13�i•i825;CRtOR938 ; ALARNATC TSDF DRUMS PIU: EMPTY'DRUNIsi FACILITY: 1350 GENERATOR WASTE CERT ICATIQN'(PLEASE'CHECKTHEAPPROPRIATE BOK) By:ryniny brfnrr V hnrrLy crrtify Ilial: (Waste oil generator/customer MU5T check CINE of the following three boxes) +111 hart hof nn=rd any of qrc wase descrdsed anpve svllh any athu Iwastruucwa,ce.the In4tl Imlitleconumt Is USS Ohm•t,oppppm,and thi wasledots rat EwrTein anOu'r..I havaccrrrpPrdwdh the requlrentnnts of luiapphcaWvCalllarnla utvtt off rnafsaBvmttnt r4l'11ladons todeselminu Ibis Is true.l alllee to acceps she additional elratgn for the disposal of sl4s wash if Ih0 mfeitmlrskn l frau"proMad ax'rhh wa ste Is Incorrect C] have nol nlu14l any of tltc waste desCrlbetladave wllh alsy ashefimryilautwastr,the coral halidr canter[h G1tfM1TEp than T,I.'W ppm.uftl thCwa}lr[IoaK pot COTllsln arty prin.i hasty ayldzd praltrr.dxyrnerslaiinn to Wand OdEIlvlronmmtdl Scrvkcr la rrbuf thr.prdsurripitn'n sh,rt lhltiwa,crw.tsmhr�dwHh othcf hpansoutwaue.l.igree co accopt lhesddlilvnif ciwrgrs Tnr rhn dlspuscl of rhes wastell.fFln lnlormatk+t I frac"pmv}dad a6aut'ehltwla�to Islncerreet ,. I.. .. � . CZ)d]}Ttoh wasta is hofria rankvA*h tollms wade oil from hnu:rhoW'dcidt•yriurself'f4f'll anchor ca ndh tonally exempt small ryuarrtis y�ttralos(COM tources,To thehest of rny.k rewledgG the only wast"o4 tujrtnindd ln.rnyf)1y1 CES06vallectson tants ti,Weyfrsim WandlorCES06 It;weas:l Fkwenot mt.ed till$waste udwtth any ocher hat.I irastvof svast"I from alhonawgtek i agree to all pprthe addhional chafgea tardlspoyf al t waste if Its¢infomwtlon I have prrnldcm knutIhi%wast"Is irll stwn (AlI generators/GUston>ers MUST read the Following text and check the associated box.) +4311 t am a lanje quanil ry,generator,I er,rsdy Ihat r have a pregram to plll[e�to+edocr 1h"vl tam.and 1--k Ty of wa5m ganetatcd to the dogi o!I have deterrrrl red IG be acanom+ralty pf,s ticnhlr.tnd khat l have s ac IN the Trach*10 rtWhOe of tstatmeftr.%WT;ige;or dlaput.d C,UF mtly YYadat,le w rrw which nt[irimuet tltv'lrfeter it ar rd.futaro Itril,rt 26l5wman 111vutid Usr enQon runs;lh.II tam a+marl qwn;fly qem rill or,s 1711 emade agood fitirl vkart ih.nrinirfrlr.e frrylvatlP!terreralFOr and sr.loci the bHt wm%il man�gPmar+t mc thud ihat y ayailWe to rw thal Ican effwd. - This ,dfvldual uytrfrtq kn Thr 5 Wt fork y:irrw("I behall td Cultunw..t iepi e.whts a+til wvxrantt lh)t Moshe has•ilu autiroslyy to bW Cwl-v ic:t•Ihat Ilia fgrrja lnp de urlptlaris of haste arrl MAI 01 Ali sue Ince and ace umla as t•d.lna+!<od and Labe to Tea f¢r lw.71f lallori in accordanrd w-it,applicable stasu and feclrrai srgufasil n and-O al Ctislompr shall ahtdr•and N'heuncl Icy the Sundald T/;W'Cuis on the it vri:r sl is Serwce Order. f / 1 Cu�fo ► i ature Mag DTIVer Si na. Date F'rintName PrintDrivcrs ame