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FDR SF-FIVICE CALL: SERVICE ORDER FORA NO. VJCES004-R(FV18j DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-804-727-2879 SERVICE ORDER NO. r-OR ACCOUNTING CALL WORLD ��L 562-231-1550 ENVIRCNI'++4ENTAL SERVICES JIFFY LUFjF rt:3�� 7xnn c1�Fvr�ora wow D�xOhr,CA[>SEtxO BROADBA INC • DR00Ch7 I - o-z�z-a$r� p 1+x71 514CRE STREET Cott I�r-rLl�r,�:��l �a• E MONTHLY Y NLLINI-= t'V:� r Cl- D LOCI, CA 85240 TRANSPORTER EPA#CAI?r} 9277'0 6ir {NES r sALaAP&wo C.A xi #1 Q 1209) 338-Opw (Dim 375-1155 CUSTOMER # PURCHASE ORDER ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES 70// DATE REQUIRED DATE ENTERED NEXT SERVICE:DATE CUSTOMER EPA V BILL of LADINW MANIFEST 9 PART q DESCRIPTION QTY UNIT PRICE CITY PILI TOTAL U- ,EU f`r,iE IAL 0,L.l`AJ,:-� 0L.a44 FiLTER DRUM REPtAGEMENT • rat?CHAR-0,17 TOTAL CASH RECD; CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LiQUI13 BUSED OIL1Ft XED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE. LIGUIa(ETHYLENE GLYCOL SOLUTIONS) STATE CODE. OTHER: _ RF` G 7GRPti :. L :,. TAr T^r DESIGNATED TSOF: --'AAE'RIRVl 1:Y AAZ0 E{31i.,�.^1 RtWSiRIAL Oil PA. 4K'IN 4STO ii,CA 953,115. 2N.9%3-_801,CAL IM4 ALTERNATE TSDF: — -- fa tJtiif :'! I'� DK aii{Qf-I • D-KI1ti 442!E XPIREi7 _ __r_ . i }fir arrl �4 DRUMS RILE: EMPTY DRUMS:T FACILITY:. _ a5C GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) Ely olgnlng pilaw t hoxlby CWtltir Thai: (Waste oil generator/customer MUST check ONE of the fallowing three boxes) Hk I hate not rru wed"OI trw,yaste daacrib[U above w9rh any OOW hatsrdou3-Bolo.tha local halide Corilenl Is.LESS Ihon f-t}N 90M.WA theWftt9 do"not"Atalrl Shp PCRs.1 ha" cprrii�dod wNh n1e nequlrrrrwrlts of the GpOlra.ble CM11TC4nla used pll r Wnegemenl regulasiw&in dermic Ihlc is true_I tome to aompt Me e.ddtionad far the ddaPosal of 049 WMISE Ir the ktlef",Worl 1 nava proyided Spent this WCL#Ir Incorrov F2 r have not rrrlreC any a!thawd95{dascrtbed atrot.E wtih any GvW 1pq-"048 a&.e,tie k"X halide ramenr le GREATER IhaA J OM ppm,ard Mg WEAW doo3 mmol C"In arty PM6 I Ila,r!pravfddd pFDPV dvtvmantailb n 14 World DLI("t0haMMta1$aniCaa t4 cabin rna pr#4{Jmpl:pn that Sril9 wi,sro was mixed with~l4RZM Esu■vnatb.l agree le nccapl trh addbtlonal Ehasges for the d15Pn&ab al This male it the InhxmMiart I11lFve Provided about lints waste Is ibGnn-m a3�7hi7 waste U Bram a lank which call4ets.wasl!oil from hGusehndd`ao`rt-yon rsal l-tile]mr+�d dyndlllbnaliy extr,Pt small quan4ty gdtl"Ot ICESOM sourrn U line best at my knbwiedgn thOnly wa5Jm oil Conlhl7ld'd In Fny DFYJ CES•OG cT,1le:di&fi tank i;Onin LH ley twin nrt4W CErif-,aoorcea I rave F191oS mldred&N9 was•�ail aistt any other lemzerdnns Waotm Gr woslt old e fm,other sour4:ee.1 n4rrs to OrC001 lha additkM l CHarifei 1pr disposaL PI Mill w pale Ii the Inl4rmedan l hawo Prodded 0o611 W"w— IC ksCdrrav (All generators/customers MUST read the following text I h,11.116 Pfd lrs Place Id reduee the vghinle and lox"of-"to q*nC erred to lM aagree t nave deltrnu:mcl to be eCbrtonSaCNry pfaeveehl■and thin I halve oO metod 1174 I Comfy triol ptaCti[obie mothbd of tredlllem oiorsov,err d4ppfal cu"OMS Y avarlahia ie me w zli it mkur-risen&.9 Prenerrl and Tulare V+raet to-human Alm end the pMronntMl. -this 1ndlvldtla si¢iJny hi brie 6th wt ioriK below on bEtB f W Cuslome{fRWRSe itf and warront31he3 he'mhe hp the authctlt>f tra tllrtd coni rrwr.1Re1 the IwVQing 0 llCrtpll9n!W WBW mmrk 11M tater-1 s cd.ftnd Imbeled.we road for lrampaetatlun IM ra CK%i7rdnnee wilh app7lbie stole end Eedarol r�ilallonm,end tlul nMarner Mull abide ort trya erFlp■C �on rav ude Of trUf`Mr•rlce�r1♦ by the gSandard TerrYli and CoralocWti 9n'I Orders wttt't an aswelated narardoua waste Mamie 4lelelOr rale o�srllFC 4r ConwFde�l are oublimt to on EPIC Fme. These iso eaves I"EPA PnsF-th+ouph 1190 erA■dministrnkmt plN rdell Prot7y�n TAesc Foam,.pry bawd on LtanIfea fype- AApIlCapls fees Nil I opgaor arI yGLi Ming inY440e Customer SignatureBete Drlver SEgnature Date I _ Flint Drlver i acme grint Name