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asp'�',n �"P FOR SERVICE CALL; <br /> '�151XON OFFICE SERVICE ORDER <br /> alb' 1.808.727-2879 ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOEsoo4-H ferrel <br /> o aSRVICE ORDER NO. <br /> FOR ACCOUNTING CALL. E <br /> 562-231-1550 WORLD OIL <br /> v; <br /> „¢' F ENVIRONMENTAL SERVICES. <br /> fie„ .e L- c n•,.-, i<Il LI 7300 CHEVRON WAY,DIXON <br /> ,.•'” r (vYAtirr��inli r2El-�iIP3 Jwi GA 9ss20 <br /> ,Y��w"�« � - •' -.-^:411 ft-.SVM 1.800-727.2878 <br /> e r WWW.WORLDOILCORP.COM 42 vv <br /> 9 y dol,+f TRANSPORTER EPA#CA0028277036 nc <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# <br /> CONTACT NAME ORDER TAKEN By <br /> DIA-1#4 (pC3 HALIDES <br /> i DATE REQUIRED PATE 7 lrwwn�aa <br /> ENTERED NEXT SERVICE DATE <br /> -� CUSTOMER EPA <br /> r111f1U21 BILLrrof LADILN�Gl�MANIFESTx <br /> PART# DESCRIPTION <br /> •..' °art-l10 LYS 1ItQTY UNIT PRICE QTY P/U TOTAL <br /> arai.:l Yat UUlM ' N U�W S tLl(,r I I <br /> gNSP('.i{dTATlON <br /> K w TRUCK VvASHOUT :A JJ/,?CO <br /> &T- . <br /> CASH REC'D: CHECK# TOTAL <br /> IN <br /> NON-RCRA HATgppOUS WASTE,LIQUID(USEOS IIJMIXEOOOILS) <br /> 1NFORMATION <br /> '�•_.�'R NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE 221 <br /> OTHER: STATE CODE <br /> DESIGNATED TSDF: <br /> ALTERNATE TSOF: - <br /> DRUMS P/U4 .- Attcfnt Mw .5-R., _ <br /> EMPTY DRUMS:_ FACILITY:__ RSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BO)() <br /> Er elEmnq hale-I Ismer narnry mal <br /> (Waste Oil generator/CustOMer MUST check ONE of <br /> ❑e,i I na..pele I..a.nr o�Ina waem ar«ehatl am;^I.Itn.av em.,n.am,,,.wn.re.me Inlnr nnna..enr..r�,gess rh,the <br /> oppowin 9 thrw.awe�boxes)n.nv.cee. <br /> IFa lnlwmahenlnare pro eon.naW,ryPje lwae,e lr�Ircprmct atJu mnagemenr npublbnetea.rvmelm rd.lrirve.l agnea baccepl me etltllllonal=nargee for me depoulpf lde wash lr <br /> J eE,nese ay el nl o ab <br /> P�w°'ee rl5ery n ry„ntlay Eenee m,E .n <br /> = rgea torr me tllapo lel Iola ween rl lne brwmaEonlM1e Pro open rboul mfr w..m bin<usren ,nlew..re betl wFM omen nexeNeua wasb.lee vrr oa e�Bal <br /> J 3)This malek IranabN whl<M1 moon.weals pll nwm heueende-psixyaumerf'1plyl sono.=emnlwlwry eae..,p[amen qunnllty g.nerewr I1ES rw.<ae Te my byIof my <br /> etl9prerWronryw WneJ Del cEEaG ppllem wWy lm aQa�.CESpp se <br /> nom dry eo.laprnbacepl meetltlJfon M1eq..to.plsposalnef lm. eln lr me lnl ne prorltletl.eeul lora wealaaeizl��vll wlln erry omv naaareous weele or wean olr <br /> (All generators/customers MUST read the following text <br /> mlN laeern�. wraan<.mea rrtl .ull,d to nan e <br /> m mellm.lmem.alrr.a.. elepeul�Inrr.nny�elleM le,�whan min ml..appn.�.;,p 1„i„m m,aamnemee .�,le°,..ew.mmy. Iln.aeeel,r,.av,a <br /> -ruama iai rler: �ma.�le taeceise�a.r�parfn:ei Z=bb.ml w1b.nan rn..mnmrrm hmhlanemmnr.m.r fn.ra.ger�gae,rr;prlea.nl,a.m <br /> by lhv Swntlmtl Terms ene Conetrwna on rhe mrene area of rob Servlv.....r. apoNrlenm eaveena wlM eppllmnG Meb ane berme!mpuween.,antl roal cuwom.r stun adpe <br /> S„rsallenllmlwlm meeen ll�l�a.dry�swanesnn Mwlkalr ltner�anellrpsbl.kes w'Ipl oeiitleletll are auqq ,o an EP u_lnw rye wears m g xe e.,tl ao <br /> o ae pmpmm sYPv pp ppear oe yew MHnlp lnytc.a nNnblmnee <br /> —L>/�ei/ <br /> Custyprger Signature Data Driven Signature Date _ <br /> Prinl Name - Print Driver Name <br />