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i FOR SERVICE CALL: � �{; ORDER DIXON OFFICE .� FORM NO.WOESD04-S(&IS) ISBURY ENVIRONMENTAL SERVICES, DBJ4 SERVICE oRDEft No. Y-8Q0-727-2979 FOR ACCOUNTING CALL: ��fLD I L N4238�$� aG2-2S1-fi550 ■1r ENVIRONMENTAL SERVICES- Q4 CHEVRON WAY.OU{ON,CA 9Wo ►+ RALPH HAYES&SON INC 1-64a-727.2879 RALPH HAYES$SOIL INC P 2-0177 S MA ARTHUR DRIVE 20177 MACAR.THUR DFUVE P WWW.W0RLQ0tLC0RP-00M D TRANSPORTER EPA it CAD028277MS r TRACY, CA 95304 TRACT, CA 93304 ° 9) eN,70 WR) 606-7000 CUSTOMER R PURCHASE ORDER# ROUTE I# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES RAL600 I LOUTIE 1 TAYLOR 8ne�r,�arr DATE RECUIRED BATE€NTERED NEXT SERVICE DATE CUSTOMER EPA 1 91LI_of LADIMCzf MANIFEST 11 2115)2023 CAL000007395 PART# DESCRIPTION aff UNIT PRICE OTV PJU TOTAL OSC USED OIL SERVICE CHARGE 1 S95AiD1 MOO WO USED OIL I MD20 OILS 400 $0-Do $0,00 B14 IR�, PAGED DRIP TOTAL CASH REG'D:= CHECK# h WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE. LIQUID(USED C4UMIXED(ALS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID{ET�YLENE GLYCOL SOLUTIONS) STATE CODE OTHER; DESIGNATED T'SDF: WORWO11, ENVIRMMENTALSVCS-MRM 1920 MORGAN 110,CEIRES CA 95058 ZI]9 5.41-I 90OMU9� ALTVRNATE TSOF: I AcDwint Mwa .Samnd Read DRUMS P.qU; 5MP7Y DRUILIS, FACILffY: 1 GENE€tATOR WASTE DERTIFICATiON (PLEASE CHECK THE APPROPRIATE BOX) My slgning Sol Sw 1 h-1,b} c"Irj 1hst: (Waste oil generatocicostomer MUST check ONE of the following three boxes) 11 LN►*ml.mlied aap or Ux weaia deaGrltwd wbo�W11%shy co C�Ihaxardou■waolo,the loiel h0II&m-fam1 b LE99 Lhe9 1,49a Ppm,Ord the meta daes not GcrdoL,&W 15=6I hov- R!wilh the mquhernent■od Lhe appIICWle C10004fil6f Nryld cm 1p:mrl, omanl requ:alfom Io dar mMe Ih1l.I*Iwo.I sgraa 6o ereopl.the sWll:!n Ichergw roe[hg d1ipaul CT this write If Ian L hres provldod■how[UJk womMo Is P*C4rlwk I d NJ]hyp■not nlsed mrry trl Lhw wan*dtAcrit+d&Nwo wiM eery DIT10 I t6mg worsts,gw 10W hu110e ccrwem Is ORFAM LuA i,=p,pm,rr d the wnic does not ronLin■rq PCIM,I flaw prgvfdod proper ddCurr w 1.0do r0 W4r1G W Fnylimmmanrsl Eon Wma Mh rebid 111E WMN111p117e 11hor iLhls waYr was eolnd wn 4LMr hLzando9s wr4hL I ogres la arcmA Gw addllloid C"ge.-for 1ho tllvpomal of Ihls wade It Lhs ind9+nrr4Wn I rove provlued�MhaA Ohio wwo b h-more9CL Q gap Jr"molelelrvinflanILWWhC*PeaLsrumonirwahousgmcd d4-IF94urMLrWMaorybra *Iorh3llgftwlCr[6magraMltypeneswt jc*10%)6w *MTeW*b1ADfrM kra ltdgw.MeOrtlrwhM4&C"NiN ItMONEs1'lfCE8Q4�allecllbn1e�NhescWyhwmELrY■makw E900roLprmf lhw*n4imisrdLNswasl&all w0hwTa"KmrdLw�wnMarlr»dl warn oMc■n ftwo,1 igrma tf 2CCW th*.PWINk nok ehargra:or d1-puull`4f Arb+44to Ir tM Iroafrmakn I hive pmvidW fb,Yllt this wasto Lz Ahoanerl (Ali generators}customers MUST read the following text I cart!IK rhai t]aY a pnogcom In plxe Ia ry&K*1ha Y4IL4rre wd toxkAlfAf wadi Q8niratfd 10 Iht A/gror.l bW dalF--rdrwd tv C**4"Cr IIFWIY PtmOm.mo.1w loll 1 P10"OPWGF 460 phjCjIgapla mMhGd of U�Irnenl,storage,fm dlepp441 GurwrdIV awllahlrta rhf WMCh TMhlIrnMn Lh1 praoen[frrd funm OhhY*1 La hyrn4n Ilia end the CmMlwm� ll. shim IndI.IdW4!alg nlno-sn the spare eel forth bolow 4m b4w or ru o,7 jm rfprnwct and woirrae4f That hafmho hem 1hf iuOl4rlth'to poop cuslrrrwr.that the farCOlrM tlblC+dpkIM4 41144s1e antl no'mrla:-are Pwa a#paGMapcd,rrurkod,mndtdhgrblt,aje reahiK for trairpaldh>•n IA1CC+s'Cawo■Wlh-ppl1=6buts kM6IlWAYri1 rsQuJIl4M1+4and Ghat cwGtomer■hill■duo J�f tns 9tandoed Whd Cantllt a an U50 hlW"s1E4 9r Mh13 ta+rvg Cidet. Smryro4 "WtIhanamwelmred ZM Wfrle rllsnlrp4l(4lnhar s7teiapealgv of C4M1e4Ptlslt4*ore m-*�a 1v on ITAFec Tlrtaa La p4ar 7M EPA pama-Ihrw�Ica ON a"Indsinglun of nue nlrr4l OrGgrom. 711M+ m 4iaq bwad on Mrdfimt fypi, A(rpiLcOlf 19--0 epp-r an I'M 90109 lrnpl9e. Customer SlgnaturoT Driver dtu a Gate Print Moore Print Driver Name