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Oct. 8. 2012 4;06PM JtKVIbt UKUtK <br /> Ileo., 39131,atalP._. .7ozl . <br /> JRYI SERVICE ORDER NO. <br /> tY OFFICE <br /> �.003-8844• <br /> ,fco OFFICE - <br /> 600-733-9043 _ "i`.rl <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE,COMPTON,CA 90221. <br /> x 1-310.8653400 . <br /> P MAXIM C-RAHE WORX5 TRANSPORTER EPA#CADD28217036 ' MAXIM CHANE W011KS - PAR <br /> E d 7;3 MARIPO43A wmx) f'a BOY rill <br /> D <br /> T ul'OGKTO14,CA 9;52475 LA FORTE. TX 77572% <br /> 0 <br /> (91.6) 45,2.-3ri'61 C?731). 471. -1?66 <br /> CUSTOMER# PURCHASE ORDERI ROUTE TRU/CK# CONTACT NAME ORDER TAKEN BY. HALIDE ' . <br /> MAXF02 112 �U sC.H)"AULF.:D 4100 <br /> PATE REQUIRED . DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> -y <br /> 111,71201" 1/17i?1312 CAIrS?�a:r54 i M�f��dol ( ✓ . k <br /> PART# DESCRIPTION. QTY UNIT PRI .QTY PIU 'TOTAL. <br /> 14060 USED OIL SERVICE CHARGE 1. <br /> WO LGED ,011- '/ MIXED OILS 700 <br /> 36S <br /> I.,Y 7ffiI.S J't l"EPI�: <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> r NON-RC RA HAZARDOUS WASTE,LIQUID(USED OI UMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED, STATE CODE— <br /> OTHER: _ <br /> DESIGNATED TSDF• - <br /> ALTERNATETSDF: 1 77 relflev I , 1 LP <br /> •1 - <br /> SA RECYCLING; 33210 Western Avenue,Union City,CA 94687 1-51 -487.9277 <br /> DRUMS PIU: EMPTY,DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> We Is to oarliy Mat Me walls desodbed above ie paraperty Classified,deeadbad,pacaaged.mahed and lab rod,earn[gin peapr twomon for nanspanaim;aeaordlnp t0 e0D11cab1e Slnc <br /> and federal rogue s0ons.By s19nla9below l alaoh.raby oMily Nal; ' <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ,V'Np 1 have put mlxgo any or she waste dee griMa above flim any other haaar'doua was to.Me to te11161106 content Is LESS wren 1,o0o ppm,and the waste deals not sorrel any PCaz.I have <br /> eomphadvellb Me rsqulremenls of the eppllcame CallforaH used ail reans9emca reohlalione to defaming this Is Irv".I agree 10 acCepl the additional charges for Ino o1str sel of Mia wail. <br /> If Mo id.haatlon l have provided about the Was t6 is In C.,ICC1 <br /> D 0'2)1 have not mixed any of the waare deecdbed above wllh any oMarm+ardous x-.req Me tole)halide cement is GREATER than 1,000 ppn,and an.waere down our tenth any nft I <br /> have provided proper QocdmanUdml to Rzhury EnvifenmMlal SeMcas M form the prorowaon hot this Whom eau mixed with they husurdo 06 waste,I as;she m acaepl the nam tional chargee <br /> for Me do poeel of Mie waste me I nlmmadoh 1 have poYaaed abodt this hassle Is fecarrecl <br /> n xal lhls wade Is from a link whleh egllocls wails ell here household'do-il-youneh-(MY)an dor ocrell anally azempl affair quantity generator(CE9e5)sou roe I.To the best of my <br /> kneededg6.we only Waal'oil eoeufned In my sly/CE506 Cogeallon lank Is sol ay fmm MY"Mot CESQG p01go¢.I have hot Mxwd this wash,oil was any other regardous wasre or <br /> waste set 1.ethd...uime.l+greaor.rat Mewdil,toot charges for disposal of M1>waste if Me husurralion l nave provided a,5'urMB,waale l+Ineort¢l <br /> �/ (All generators/customers MUST read the following text antyfheckthe a ated box.) <br /> .Qpa)dl amal.rS,qu.naoygenlsmtsnl Cadlfylhhtihavcamoyram in place to reduce Mav0lumeenploxldry of..[.p Ro"Wo to fAe d+gree lh a 0nsrminsa labeecvnam;eelly <br /> practicable and marl haveal..1all Me practicable meMod of beahh..a era,age,o/alepoesl ebttebliy avarstbl.ro mewhicnMYoints ..M,pe6eg5 a future threat to humthhh,and <br /> Me mvi nnw0l:Of,Iflam asm>�I qua glygMereloglnaw mala age Va labp eNanmminimisa my w6810 geneYallon and¢elect Me be[I v/az na9unelY m+rAoa lnat is av+Il+Dle <br /> b titan from.. <br /> f(''` <br /> ��f-,d , ..., ��.� <br /> cu�gmerSig pe / Date Driver Sl rartura- / Date <br /> 14Jr_ Nis IIJ '+ .0,rrrrl�, <br /> Prin N m----��--- ----1— —���—Print Drivers Name%`--�`-- - - <br />