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FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> 559-498-0240 O SERVICEORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> 5 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> P <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> 0 TRANSPORTER EPA M CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER if PURCHASE ORDER a ROUTE g TRUCK g CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA a BILL of LADING/MANIFEST If <br /> PART 4 DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> q I TOTAL <br /> CASH RECD: CHECK a <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE__. <br /> OTHER: <br /> DESIGNATED TSDF: ..__._. ,- <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY:___-_ BSC_ <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signerg below I hereby serdfy gi <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Ont I have not mired any of the waste dessnbed above with any often ingenious wane.the total munch consent Is LESS than I.000 ppm.and she waste does not contain any Kgs.I have trwi had with the regwremenud <br /> th....lkable California most if management regulations to determine this is true,I agree to actors the additional charges fid the disposal of this waste If the information I have provided ate ut this waste is Incorrect <br /> Oa]I have oto mired arty of the waste described above wish any othet Inattention waste,the total Mode content Is GBE.ATEB than Lend Pumend the wane dues not contain any PCBs.I <br /> here provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mlaed with What haaa(dous wage I pin to accept the addgiorlal charges for the deposal d this <br /> waste H she Information I have provided about this waste is Incorrect <br /> O HI Thr,write is fight a tank whichcollects wour from househodtl vyomi Myland/orConditionally temps small quantity generator(CESW sourtes.To the beg of my Incesedge..the only waste of contained <br /> in"MICESQG collection taM Is soley hon only and/or CESI G sources I have Trot mined this wage oil with any other hazardous waste or waste dl from ashen sources I agree to accepr she additional charge far disposal <br /> nl this waste II theinbrmafdn 1 have prwded about thh waste is irscornt <br /> (A(I generators/customers MUST read the following text and check the associated box.) <br /> oaaPIamalengequantrtygealoftr.l ment.shatIhawappgalc currently <br /> toreducerhe which andtoaehyewanegeneratedforthedegreeIhavedmombadmbeecovom¢ala a,mklbuandthenInave <br /> selected the practicable method al trntmenn.storage,a tlisposal currently availade to me which minman Ne presem add future Mreat ro human IBe and the enrNgnmenn Dr,N I am a smell quantity 9egmtu..I <br /> haw made a good faith effort to minimae any waste gingri atlon am select the nem waste management method that is available to me met I can afbrtl. <br /> Thismdiridual slgdng In the space set forth oelow on behalfof Cs whernepresent,and earnings that he/she Ms she aushodry to bind Customer,than the towery,desaiounds of waste end materials tet true and!accurate <br /> as p.,N,ad.maxed and labeled.are,eady(or nmgpntannn or aranrdame wish applicable snare and federal requlalions.and the,Cost..shah abide and he bound by the Shormard Terms and tondherns on the reverse <br /> side of thlr Servke Order. <br /> /— <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />