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<br /> R SERVIGEICAL1.' FORM NO.
<br /> R tER ASBUI- t>F� N'C kl.SER1/IC'E5 DB x77
<br /> 59 ""W ERU(CERDERNO j
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<br /> FOR AC GO,UNTING CALL
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<br /> 52:231=� 71 ..r "'OXY.
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<br /> 1421i7EA5TMANNiNCAVE;`PARLIER$t:A93648
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<br /> CUSTOMER,# PURCHASE ORDER# ROUTE# TRUCK#' CONTACT NAME., ORDER TAKEN BY HALIDES
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<br /> ` D F?EQUiRED. DATE ENTERED,' NEXT SER lICi DATE W$TOMER EPA# BALL bfLADINWMANIFEST#
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<br /> - TOTAL
<br /> RAR # DESCRIPTION" QTY UN1TxPRICE' Try"M a r
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<br /> Til eT
<br /> �OTAL v
<br /> CASH REC`Da ,C1 lECK#
<br /> w WASTE DIROSA1'INFORMATION �..�
<br /> NON-RCRA HAZARDOUS 1NASTE;L1QUlD{USED OIUMIXED OILS) STATE COpE 221
<br /> STATE COD
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID{ETHYLENE GLYCOL SflLUT10N5) r
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<br />` " )51GIATED"SDF;
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<br /> ALTERNATETDF; .z.`�
<br /> -� l ""�t �1 f 3.„"3x.:., } r.. �A { ;-t
<br /> QRUM5 P/U;_�, a >rNiR 'l DRUMS_ "
<br /> GENERATOR WASTE CER71F1CATI0N(pLASE CKECK'fHE APPROPRIATE BOX)
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<br /> S` .=s5'}f r...'3•r "�. Er. s{ „ k- gid'-c,` x,f
<br /> y,_ (Wt o�(;'�eneatolcrst� erMUST� heck ONE of theollo thT �boxes)
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<br /> toolied with the rggp,reMeP0 of•
<br /> an afthewastedescribertatwvewithahyotherhazaidouswa;fe;thetotalhalidecontentisLESSthant,000ppmand3he.aseei'fth�informttonJhavepovidedaboutthlswastetsincorrect
<br /> E:j#l)I have not mixed y - gg
<br /> theapplicableCelifotniausedolirrranageneniregulationstodeterminethisis,true.lagreetoacceptiteadditional charges t ¢
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<br /> ` n.ofthe waste desalted above with any other hazardous waste;the total halide contePt is GREATER tkiah i QQQ PPm and the wasfe does riot contain any PCBs.i
<br /> „ C7t21havenotmixeda,y
<br /> tl t'v= o t)Ali)nKironmentaf$ery)restore¢irtiheRJe3dmP ofi th7 astewa�fitixedw7firAtherfiazatdouswatte)agteetaacopttheaddihonittlargesforth€disposaiofihis .r
<br /> have p[oViderl,ptoPQrdpcsiinerita 4P, fl ;
<br /> wastetfthelPfomationi�iaveprpYidedaboutthis.Wasteisitrcorrect x i "
<br /> r „w. r>. .,.tit f ESQCi) o tsesTofh 3tfmY 9< onlY?2astgpJted '
<br /> x:-:, µ ,.,, .. `. .• u el„�I atid/o. Pd1 wit
<br /> aitX<mE fnali qP 9@Reda 4t �!_. g :,.>
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<br /> pit3)Thfswastefsfro ata hi, leatswa3te�il„from q fro rid rs� ° ,xr e ---'
<br /> in myDlY%CStlGcollectiontankissoleyrHomU1Y'and/oiCES 'ssouices aSeno inize thiswasteo)wt anyo erhazardousY+asteory+asteoilfromothersoutces.l`a reetoacce ead rtionalchar a 4t o o P
<br /> of this waste if the lnformationlhaveprovidedaboutthiswaste Isincorrect
<br /> (Ail:generators) Customers`tVIUST readahe 616w ng gtenea redthh dekrmhe a ined tobeoo�amed boxabl it tihava
<br /> v a o'r min )ace toreducethevolumeans toxid of}vaske9ereY t t rt
<br /> l4lftamala equantityg0erator,icertifythattha a Woo trP :«; .,, r. 1- {� ” =#'ntan(7ti:.uirlr'e�threat,. }isan'tiie `ndfheenVi nm n�`0 1'famarsrnal( arstity`en¢aorl`, '
<br /> f'.a racticab `rriethorinitreatmerrt storage ord(ttos�5currenttyavafiabietou(pw� ifi?rh iz€f e fla etofie{`at Sr a •t
<br /> select P.,„
<br /> havemadeaggodfai�effojttoirrinTmiemywaste'generatio�yandselectthebest'v+asSQmanagQr�ientmefhodthatTsavai� .•�,_,t A ��f„, � �Y ,
<br /> This Individual signing In the space setforth below on behalf of Customer represebts and warran
<br /> tsthafhe/shehastheautho'r(rytobindCustomer,thattlieforgo)ngdescriptionsofwasteandmater)alsaretruer,dccutaie
<br /> s.
<br /> P' aspadwged,markedandlabeled,arareadyfortransportationlnaccordariceWithappDcablestateaniifederalreguiationsandthattustornershailabidean be boundbythestandardTermsandCondiSiyr�rst�nthe�reversg
<br /> side of this Service Order.
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<br /> Drive i t rc 'M
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<br /> C me 15� �# � � �•. Date'
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