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FOR SERVICE CALL: • SERVICE ORDER •
<br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17)
<br /> FOR8.0240 SERVICE ORDER N0.
<br /> FOR ACCOUNTING CALL: 0
<br /> 562-231-1550 I �
<br /> WORLD OIL
<br /> ENVIRONMENTAL SERVICES•.
<br /> fl 14287 EAST MANNING AVE,PARLIER CA 93648
<br /> 1.559-498-0240
<br /> p
<br /> E WWW.WORLDOILCORP.COM
<br /> 0
<br /> T TRANSPORTER EPA p CAD028277036
<br /> O
<br /> CUSTOMER p PURCHASIORD111#9 ROUTE ET TRUCK x CONTACT NAME ORDERTAKEN BY HALIDES
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA x BILL of LADING/MANIFEST w
<br /> PART p DESCRIPTION CITY UNIT PRICE QTY P/U TOTAL
<br /> TOTAL
<br /> CASH RECD: CHECK x__
<br /> WASTE DISPOSAL INFORMATION
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXEDOILS) STATE CODE 221
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> OTHER: —
<br /> DESIGNATEDTSDF:
<br /> ALTERNATE TSDF:
<br /> DRUMS P/U: EMPTY DRUM4 FACILITY. RSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX)
<br /> ay,W nm9 di I"mem,term,Thai
<br /> (Waste oil generator/customer MUST check ONE of the following three boxes)
<br /> DI I I I Leve wt rrv+nf am t9 dw wane OeunbM af¢m•win anY ane.naza.Joua w.em,me sinal nalye<ummt
<br /> "I'll mm•tau m—,and rhe waste tice,art wnaes,xry PCR,.I have com A w,m[h the"whim.m a
<br /> the-,Nimble California—d!ul management regulations to dad a rnme this is true./agree to accept rhe aldhunal charges for the disposal of this waste N the inbhosmon 1 have provided about this waste Is Worrtct
<br /> 1]021law•nm mord any of Ind waste tlescnbM eMve with arty other hazardous waste,the lotal Yallde mnbnt n man an 1."Ppm,and the waste Joes ret tonain any KRs.I
<br /> hand Prowled proper dIXN,lenUdion tP WM1Id 01 ftlyYpM1e11ta1$eNKIS td OgA,Ilse WRods"A"dta(this WM(e Was mlMd Wldl faire IWaardoul WaSle.I agree--[Cepa the additi-nal charges Ed,rhe dl5pa5a1 Of 1hO
<br /> waste d the Information I haw,provideC about this waste h Indar tl
<br /> =1 131 This waste is from a tank whhh ollects waste all from homelmM'do IT mortar(Ont and/or ronditioddl,.,,small 0uanmy genenitA,ICEA)Gl mattes To the best of my kmswhod d,the only waste al contained
<br /> in my MiUSM cogechon tank Is sdey from D yand/or CES05 source-I haw•1.m.WJ Mia wane nil with en,.1T,,haead,w,warm or wore w from other snmces.l agm•ro accept the adtl¢nlnal Jarges for Nilwssl
<br /> Of this waste If the Intonation I have molded Roan this it.is mcarect
<br /> (All generators/customers MUST read the following text and check the associated box.)
<br /> MJA9 It I am a large quantity gerer.t.,I tariff,that I have a pogrom m of..to reduce the volume and tmmny M Waste genaatM-rhe degree I Isar derennined to be et ordnwally ptactirable and that I have
<br /> strothad the Isattkable method of Ireatm ml,s mage,wdlslsosal currently a,,wI. fe to me which minimiors she present anal future threat to human life am the W-mnmenb Or,R l am a small guanm ,gdOW....I
<br /> ham•made a good latih eeat to nimmue my waste generation and adtpt the bot waste marNgFlMnt method that Is available ro me that I ran afford.
<br /> This IMivldual signing In the spate re,forth below on behall of Cuaom ar represents and warrants that he/she hal an,authority a hind Cunomw,that the targoing dosmpbms a",a and oWtetbls are vise mrd-dinar,
<br /> as packaged,marked And labeled.ate ready for transportation in atcordence with.1Pleable sate and federal tegolaliam,and that Cost.,."I abide and he bound by The,Siaatard Twins and Cooddion,on the reverse.
<br /> side Of Service Order.
<br /> j
<br /> Customer Signature Date Driver Signature, Date
<br /> Print Name Print Drivers Name
<br />
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