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FOR SERVICE CALL_ SERVICE ORDER FORM NO.woesooa-a(sn 0) <br /> DIxoN OFFICE ASBURV ENVIRONMENTAL SER VICES OBA <br /> 1-BOd-929-2879 SERVICE ORaEA NO. <br /> FOR nCGOUNTING CALL: .��®� <br /> 5fi2-231-1560 __ <br /> EN VIRONMGN TAL SERVICr S-. <br /> JIFFY LUBE ft508 vH_ v cn nsHso BROAOBASE INC-BR0009 <br /> 1130 N. MAIN STREET wwW.wORLDOi[_cORPcom 1471 SHORE 8TREET <br /> MONTHLY 61WNG W0 8a 6F TRANSPORTEq EPA#GAO02B29T09fi <br /> MANTECA.GA 05336 WEST SACRAMENTO,CA 05601 <br /> o (209)239-0665 (916) 3751155 <br /> CUSTOMER# PURCHASE ORDER # ROUTE# TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> 1IF668 ROUTE 12q DO 1 DOUG SCHEDULED-O <br /> VATE REpVIgED DATE ENTERED NEM SERVICE GATE CV8.TOMER EPA# BILL of LAOfNCJ MANIFEBT.Y <br /> 2/14/2010 2/5/2019 CAL000011032 1� � ��� `,� <br /> PART A DESCRIPTION OTv UNYT PRICE pTV PN l"OTAL <br /> PFO PAY FOR OIL - sj G� <br /> aAl'CJf i <br /> TOTAL <br /> CASH RECD: CHECK N <br /> N Y WASTE DISPOSAL INFORMATION � — - <br /> ON RCgq HAZARDOUS WASTE,LIp VID(V3 OI✓MIXED OILS) STATE CODE 22 <br /> NON RCRA HA2ARDD US WASTE,LIpUIO(ETHYLENE GLYCOL SOLUTION6J STATE CODE <br /> DOTHER. <br /> ESIGNATED TSOF -i5 �Me+rRdFeftE^ITit-3".eTt ^ES:�ERE4 t 6RC��AI�rRE-CER�h9Y�5BT^O3)3 .-CACDHP3v 9 <br /> ALTERNATE TSOF' <br /> �.�Ss�'�fc�G—(S*ty'Eh<-I GC.'-tP.-F_.'�'.`T7Y�<rl. -OF':]:Xi3YT ., sYManaS�'�Sam4vre� - <br /> ORVMS PN: EMPTY ORVMS_______ FACILITY: B50__ }1 <br /> GENERATOR W45TE CERTFICATION (PLEASE CHECK THE APPROPRIATE OJ'j) <br /> ..ma eerie..�..�..m am F` ) J Z�7V <br /> �I `(Wa oil ge ato flcus[omer MUST cFlacK ONE oT Yhs following tM1[ea [ooxas) <br /> ,.... �.e��p n.w __ <br /> `no.n...m..n�ai.�.........r.n�:......�.r..��..re.....ue..�neje e.e..m.0 nea...mu..o>m.a i.......oaa <br /> r.�m<n.e..�...�es.�.....�.......��....•...�...r.nn,..,...n..,ae<..,.n..e....�ne oma...��....n. m......>.....�:....,r.e....�a wo.......�..�..���u.......�. <br /> (All gen etato�s/c s[omers MUST r ad Tna Tollowing test <br /> ..i.n.-Y.�.. ..=r`..u.....••uce..e�ne..z..��..�....�o�rue .. .�es.«o...•..,.«..v^or�.�.e..�e:c��sn..�...<<.�Q�^tl.u� ....... rnr._.n�..�...a.r.�c�m...u......�a.e�mnc <br /> � ;� �:���^.��,�..�e"..F._�T �2 _ ItP ,lq'� PZ_i/�-__ ___ � � DLL . L� <br /> Cu st A /Sig !'"(�� V � 5 4( -y Vn <br /> PI <br />