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N WWW,1WbRLDOIt:00RF?C(�M ' it 0 <br /> ¢r� TRA0- OR §16376 A <br /> TER SPA # CAWj <br /> l X2$2770 6 iolilot 'l i <br /> T 1 yyy � ( ) 47404 , <br /> tzrd � tr . ; . . I ILL <br /> " ' ORDERTAKEN 8Y HALIDES <br /> CUSTOMER # PURCHASE ORDER# ROUTE # TRUCK # ' { y( mlf <br /> 131 <br /> J�� mot! � ' " ' ° < c t ' � � CUSTOMER ET'A # BILL of LADINGIMANIF)�ST # <br /> DAT E-DATE ENTERED ` NEXT SERVICE DATE <br /> ir -L mot , <br /> " A, „ . ,. „ It , .- "QTY UNIT PRICE Q fY P/Uol <br /> TOTAL <br /> PARi # ` � : ' 1�ES'�RiPT10N <br /> o <br /> d 7xxmo� Ito a to <br /> ait I <br /> ;�i <br /> .io A .. 1. Y 7 , .�1, :, e, 3s II.IN ., ,ar rt „ i IIH <br /> Lot 1 <br /> Lo too I It <br /> itt If <br /> 7 {� X , vI "f- f J j }�'.5. .�r Fx . .+., i .rel" <br /> ell,I <br /> IV <br /> Wait 4 <br /> 4 It <br /> r <br /> �, ,_� � t:, +; a .,,,,. +,r �, TONAL . <br /> it o <br /> CASH 13EC b CEIES1 <br /> ( t <br /> i xY Y C , Y 3"L,E' t—'� x 1 5 �` ASS' too <br /> l� 7 Y % <br /> Vi! tomiVILIP E DSPgOSAL CNF MdTlO <br /> �. , : ._ �f,� r � � ,,' , , ,, , � <br /> NIVIV m, I, I " " " STATE { DE �2t <br /> NON-RCRA HgZARDOl3S WASTE, LiQUID (USED.OILINIIXED 11 <br /> (51 to <br /> 2. 11 S). STATE" <br /> CODE ` V-I, <br /> NON 14 <br /> WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) ' <br /> mi , III <br /> °'DESIGNATED tSDF: ° `: <br /> AL TERNA7E'TSDF: '' <br /> IV,+ tittol % ' '5 . 3 ais'f V5It 3 tl -'Imolo LZt r �s ` Ittv <br /> "''n <br /> 'S } a £ 'S t <br /> %loot <br /> Vit <br /> ILI <br /> 1. Ito- <br /> ENIPTX bRUlulS <br /> DRUM ' IJll� i ,. : � <br /> t It <br /> GENERATOR1tVASTECERTIFICATI©N "(PLEASE CHECKTME'APRR©PRIATE BOX) ; <br /> B it <br /> signing below i hereby certify that <br /> Vtli 1 ) ,�tlWit' .Waste oll. enerator.Icustarn I MUST check 4NE of.the #ollow( ng three boxIli es) <br /> mi s I -vf , * .r .,� ' � ' ' % m, and the waste does not'containan'yPtilhaveIt' Iedwiihthere uir$men}sof <br /> „, ... <br /> 4 . <br /> t' % iVai$ rtescfli°d�1 o4ewltti no 'Iefhazard`oiiNtase,{h ot1fii5ldcioFifenfl'sLES iesfortdheds osalofthiswasteiftheinformationIhaveprovidedaboutthtswasteisincorr'ect ' <br /> Cllf7) itia�L6 �ioCfii�xetl any ofit l e . Am <br /> theapplicableCaliforniausedoilmanagementiegulati6nstodete ' Ine this strue. Iagreetoaccepttheadditionalcharg P <br /> ve "i '0n ;ofhe'r]ra7�[dousyyaste, thetotalhalidecontentIsGREATERthant,000ppm, andthewastedoesnotcontainanyPCBsi sforthedisposalofthis <br /> [�ik2lhavenotmixedanyofthewastedescribedabo fH 11 , Y s� : aKd�> p�gum '%�I • �� hswastewas,mixed itbQyShP,0AZardo % , ILIIt . iagfeeto�acceptthgadllitionalchar14 <br /> ge . <br /> havgp �v < ,( d - `"e>ata i 0 °?"°lid oitEnvtror7„enzal sgrvr,4 i F4, ' ���, �1 � 4R. � �a % ; r. . . <br /> a rox1 PRI f ia �v + { „#� <br /> wastef tl1g, ��° �. Yg R , � , ., , . . . s <br /> lotIliptVx£. ' t , 31i >z1,33v +mil,? Lot, _ : t it ,i. -. 2 % _, , „! .. <br /> , , ; i# � _ , . � � - - — m ' trtsali ` uantitygetVeratop(CESQG)soutcctTothebestofmykntfWied�e�the'onlywasteollcots�851 <br /> ' <` eotlfrorriousehviti'c7b it=yoUrsetfs(RIY) a�id7dt- E16fotiallyIeite, p ft, 9Vol <br /> C�#,3)ihidiVastersfroltifi{ankWhichcailectfvJast :. ^+ '�•+ <br /> hmGES( c81CitlorlankdolefoorHb)Vnd�btCE5QGsourtesYhavehotriSlz'e"'ifthtsiva511witliailloiii6tiSzaYti6uswa�turwas3eaifffoathersdurcesaagreetoacceptthe�adldonalchargefo1­7id P r <br /> I It <br /> of'thls waste if the information 1 have provided about this waste is incorrect , „ ; ..3 <br /> } . (All generators/ customers MUST read the followof aste ehgI enea 9 dee ihheed kthmine. bem� asSOo omiecadllypaOctkableand that ihave <br /> a1 e. ua0`titygeneratorlcertifythatlhaveaprograminplacetoreducetheyolumeandt x ty <br /> Clkg) I iaM%itry,arg , � current(' available%tamevhich•minimizesthepresent and fUtUre`#hreattotlulitanhfeandttieenv)ronmenFOriflamasmallquaMirygenerator, l <br /> selectedimit,the PK?TticabiertetNbd'oEtrE�trHentstoYageordisposai11 it <br /> f (th'elfbrCtoiftttizdhiwastei�eriesti¢1snd�Selei tMeistwastemartagerYtntmethodthatibaYailabletotttethatfc�fiaffaYd <br /> taveitledeaYtdd ai V, an <br /> _, ' =^ "`"' " r )s3� 1 ' i ` , S , It <br /> .+ t ` eh stheauthori tobindCustomer, thattheforgotngdescriptionsofwasieandmaterialsaretsonthereverseIttje <br /> fhis lhdiviifua(signing in the space <br /> set betovron behalf of Customer rep <br /> resents'anlviarianuthathelsh tY <br /> % <br /> asliit <br /> pa`sl,, i), narkedand9abeled; areiea8yfortransportationinaccordarleewitbapplt6blestateandfederalregulations, arfiithat Customer %shallatiideandbeBoundbythe Standard Terms and Contlitlon <br /> sideofthisServ1ce0rder I .Low It � <br /> iX43 ,4' is l: _ i s rx .n, s .�'+ % s . � z i , �y. .,f - i.�,... f �,};a .� ''` 1s# 7 x > - <br /> lit r DriverSignature bate "om ` <br /> dust© ALA <br /> mer 5i�nature Date14 <br /> 11 JAI mi I it <br /> ~ <br /> j f ;'s <br /> � ' <br />