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FOq SERVICE CALL: SEFIV IC.E OF(OER FORM NO.WOE5004-R(8/18) <br /> OIxON OFFICE gSBURY ENVIRONMENTAL SERVICES, OBA sERVwE ogOtiR NO. <br /> Y-606-T 2>-2879 <br /> FOR AGCOVNTING GALL �®p��®. ®®• <br /> 562-231-1550 YY RR Bs - <br /> ENVIRONMENTAL SERV ICES... <br /> 7300 CHEVRON wAY nIXON.CP.fl5626 <br /> JIFFY LURE Yf598 :-3voozT-zava BROAOSASE INC-HROOD9 <br /> 1130 N. MAIN STREET Www.wogLOO1LCORP-coM 1471 SHORE STREET <br /> MONTHLY BILLING WO 8a OF TgANSPORTER EPA p CAOU2S2TT036 <br /> MANTEGA.CA 95346 WEST SACRAMENTO.CA 95691 <br /> � (2091239-0a85 [91813>S116a <br /> CUSTOMER# PURCHASE ORDER# ROVTE# TRUCK# CONTACT NAME ORDER TAKEN aY HALIDE$ <br /> JIFRaB OUTS t2 I.Fp pl DOUC3 SCHEDULED-O <br /> DATE gEOVIREV DATE ENI EREU NF_X'L SERVICE VATE CVSTOMER EPAN BILL of LAOIN[i/MANIFE9l'Y <br /> 12/�arzola 1?l19/201a cALDDDD11as2 1 '-1 l'S <br /> PART# DESCRIPTION OTY UNIT PRICE OTV PN TOTAL <br /> PFO PAY FOR OIL 180 X3(7 <br /> BATCH s <br /> TOTAL <br /> CASH RECD- CHECK.# <br /> WASTE DISPOSAL INFORMAT O.N — — <br /> NON-RCRA HAZARDOUS WASTE,LIOVI[f(VSEO OIL/MfXED OILS) STATE CODE 321 <br /> NON-RCRA HA2AR000$WASTE.LIQUID(ETHYLENE OLVCOL SOLV TIONS) STATE CODE <br /> OESER: <br /> IGNATEO TSDF: �1i3tlRY-EHYfRBNM�vcri��ERViCES�E`ERE3-l9'LO-MORBMYRa—@ERESCA95938C2O9)r+!'!�!6'I5�E'AGU09993AB0 <br /> ALTERNATE TSDF: I <br /> -C.mss--Strcvls--EltAf--BFE'FBO1-Ff3EJC�5P24YN-OK-01X0N Aeca:m!-Mnnsa�-$n:+l�Rr•ad <br /> ORVMS PN: EMPTY ORUM9: FACILITYa SSC_ <br /> t3EN ERATOR WASTE CERTI FIGATION (PLEASE CHECK THE APPROPRIATE B X Y' <br /> Y(Waste g❑ ga afor/c ato r.M UST cM1ecK ONE of the following tM1r®�¢`�p s) <br /> ter..-rr.�� ...�v.�..nrrwoa..,r.nmmex. --. -- "n.ase-d"_.�."�`r.�s..ar_ mns°"Qiorr' <br /> G •m:..ro.....e...,:.�u..unm wu....�:a uo...m.R.eu..e.uun:m:: <br /> On..w.�e.m.aim=�.a er m:...au�n.n.✓.,e....mre.an...o.wmm�eo....n....��«euh�e.a, ,. . ...esu..e...n...n�.a.:o..:..�e...�. vo.ne...�...n.......r,�a.»�.,.on <br /> .Am=n.m.....�...,=aw m.«ep m..mne..m=n..a.�re.e:.m...m.n:......e..,v mom...r.......v....:n...o 0 <br /> (All generators/customers MUST read tM1e follow[ng teXt <br /> e .. � e �...... .o o m.... .e....�ou,e.m..m�e.e...�rm.m t e:a��.�. '.,...o.,�..:.0..>;.Ra`..:�..e.o........n eme. <br /> .'•.u'�in:`..,..n a...a.. ..�....:. a .. a .a..n..vaso.�..m...wn,«�..+en....m.nmm.. <br /> _ �/�t�—u��''��,.2�/.1�::n.oa_..e.........,::^�r:a._�j'�--���(//�//J;/y�/�� — e(2s2�1� <br /> � �e De ` Porl../e�J s��.�J:,n.../.(e� � Hale <br /> � �eCl^'� ��, S`-¢� _ �f' Ortve�Nan�r1..a/�^ <br />