|
AR SERVICE CALL: SERVICE ORDER FORM NO,
<br /> 0N OF@CE- RY ENVIROq
<br /> .�NTAL S�RVICES
<br /> DBA
<br /> 36 ,,0.130ER'NO.
<br /> NIM4"
<br /> _&P,94L
<br /> 552'231-1550. 1 A,I
<br /> DTAC6441ENTAC SERViCES. ,
<br /> 1-6HEVAON WAY.-DIXON,GAeN20tn.
<br /> -
<br /> &WA
<br /> N
<br /> P AVE
<br /> P 2142A, a it
<br /> o A S (W
<br /> NfA
<br /> 120,
<br /> ,6rLVIift`!gm P Owl;
<br /> _W7'4 A
<br /> a MIR ,W jQdI+Vmlso" vlrvmw;- d.
<br /> PORtHASEORDER-# -WOUT #'[100 r,
<br /> -NAM� RpE R TAK
<br /> t N;8Y -"OHALIDES.
<br /> 7
<br /> C 'W -f
<br /> EW MAIVET-11ING114-
<br /> ci ,,,lanai1 14 bp6--91% —U.2 iliVkAt, -1--C?A_lw•W#elq-,:1. -I Iwo -11491510.14 91.�44%0 A Cif*9 ,,n,
<br /> DATE REQUIRED ...... DATelENTERED NEXr.'SERVICE DATE Ci]6TM
<br /> tit ky,
<br /> (,r*jtqWvMq", r.-gk,.-ff 'Ai "W"
<br /> ,TqaxVMp)�ftr-W., �0;1 0-W, --j;,-yj4 041 P nhe,-1J"R fq,,f Pr
<br /> A,
<br /> TOTAL
<br /> %
<br /> WGALLO $104.00
<br /> NW1-DRUM REWtTME
<br /> W I i-nit
<br /> }.w; Awn 10. 1� A'-*&--k�aru)e" 1-1�11.
<br /> k.r.
<br /> f
<br /> t X%=
<br /> a0ct4 OL
<br /> N
<br /> j, �Wjffjff MM=r,,WFjjf—.:1: r.1.11T
<br /> t&M
<br /> 4.M It.
<br /> (tNIDNxRCRA,HAZARDOUSWASTE,,-LIQUIIDfq�YLENBGL�YO�OL-SOL-UTnON�l�'-.,:.,- 8TrATEtCO9EL--. 1--
<br /> OTHER:
<br /> 19L"TED T DF
<br /> vA Ta
<br /> heel T�
<br /> Ilrl
<br /> -4,4.
<br /> DRUMS P/U'--L— EMPTY DRUMS: FACILITY:— SSC
<br /> Gy signing below I hereby certify I hat.
<br /> (Waste oil generator/customer MUST check ONE of the following three boxes)
<br /> n Ott
<br /> ride d*�bad j�boyp i�ljp say hz�p P
<br /> In LEAS. 11�=,?K the waste aoss not con Wn any RCSq.I have
<br /> to�--4 -10 Wo, CtorjW for j" of f
<br /> orm Oct is� ilits waits I
<br /> tiro I
<br /> is of trIa appilvablo Cal'jorlila used atf
<br /> carpqV fpQW
<br /> 'Q.11"d*—Ut thkq waste Is("Ciffrile, j
<br /> n 121 have not mixed any of the waste described above with any other ha zaidaus waste,the towhawe content Is GREATER than 1,000 ppm,and the waste does not con
<br /> hare.provided proper documentation to World 011 Environmental SamcwvD rebut the imaumptlon that this wobt&was mixed with other hazardous waste..("m to accept
<br /> chargee for the disposal of this waste if the information I have provided about this FrantO is Incorrect
<br /> #M*Nj(WSi*lilroih's trinl6which collects waste oil from household"do-ft-youftalt'(IMY)'&Fsajff Cofe4fflofttry WM'h*sm0 quentitj 9T"!r(PESOG)souross.To Ow best of MY
<br /> vi heir corrhi'lhad ln:iny Djy/CE§00 in 66jej WEA bfy j&1yoridESba itdljfced.-I heirs riot rNmd this*M%oil vXth any oWer hazardous wast*or waste all
<br /> I G%"ioakePI 0*&dd1tk"I'Cha!R3fO sf� IPi4iswisinc6reect
<br /> .
<br /> (All generators(customers MUST read the following text
<br /> lcertify that ihave oprogram in place to reduce the volume and toxicity of waste generated to the degree I have deter"Vned to be economically practicable end that I have retched ttn.
<br /> Practicable method of tramirnant,storage,or disposal ctrffsnUy available to me which mlnImjz*s the present and future threat to ftmum His and the OnVIFO."tattL
<br /> jjjjsrjfldMdJW signing in itho OPWO,at forth below On behelf of cwstorner raprosattts and wgrrant%that hagthe has We stahoft to.bindd
<br /> am for tmMsportsuo"In AccordanceNith applicabla,state and federal r.0 iiec"Pto:4 .tl.me
<br /> and miswWa.am 4w and we,raw as,packsood,marked,axod that aust. :,; '.bldqs
<br /> by the Standard Ta6rms and Conditions On the reverse side of this Service Order.
<br /> Services Ord.A4tin an asile0lated hued.us waste manifest(either site specific or consolidated)are subtest to an EPA Fee. These fees cower the EPA pass-through fee and admInlat.r.allon
<br /> the EM 1 09 These lees vary based an Manifest type. Applicabib fees will appear on your tilting invoice,
<br /> C
<br /> —LL
<br /> tomer Signature Date Driver Signature Date
<br /> a Print-Driver Name
<br />
|