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SERVICE ORDER <br /> FOR SERVICE CALL: <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> 559-498-0240 O SERVICE ORDER N0. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> H 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> r <br /> v W W W.WORLDOILCORP.COM <br /> E <br /> D TRANSPORTER EPA if CAD028277036 <br /> T <br /> C <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKENBY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA a BILL of LADING/MANIFEST a <br /> PART# DESCRIPTION QTY UNIT PRICE I QTY PIU TOTAL <br /> 27 — Zl TOTAL <br /> CASH RECD: CHECKp <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID IETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: ---- ---- <br /> DESIGNATEDTSDF: - — -- <br /> ALTERNATETSDF: – ----- <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By slgnlrg below I hereby cenlfy that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Oall M1ave rat mlaetl anydthe waste degribed above with any other harardou+waste,thetotal Mllde mmem Is LESS than Ixbroppm.andthe wave doesnotconlalnarw Kos.I havecandled wuh the requirements of <br /> the apdkabk 011bmia used nN management reguletiom m Meimlise IMs Is uue.l agree to accept the atldinrnal charges tar rhe disposal of Itis wase i/the inkrmatron I hm prakM about Itis wave is Imorxt <br /> pal l have not mined any of the waste described Shove with any he,hxekous waste,the total Made content is GBEATFA roan 1.000 ppm,and rfe wave does net tomato any,CBs. <br /> have provided proper docvmentatron m Wok 011 Ensmonmental Services rp rebut the presumption that this waste was inured with offer haraul waste.)Sayre to accept tfe adtlnional charges for Me dhposal of this <br /> waste If the information t have pranced abort this wave ismommi , <br /> i Thb wage Is tom a lank which.fleas wage al from housMok'do-n-yoursea'(DWI arM/m aondhmneay oewil small guanslry general.,ICESgGI wanes.To the bel of my browledge,tM only wave dl mnulrsed <br /> In myour,CESQG collection tank is soky from DRY andror Cli sources Ihave not mlaed this waste dl wnM1 anydMrhazallovs waste.,wane dl from cher sguraes)agree to accept the addlibnat thargesfa tllsposal <br /> d Chit waste If the mrormatlon I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> Oa41 it I am a large gwmdy gwle,atol,I certify that I have a program In dace to reduce the volume and waklty of waste generated to the degree 1 have determined to be economically p,xtlaame and that I have <br /> SeacoM the prxtkade method of,odano d,slange.or disposal smeni avaaable in me which mimmues the phisenr,and fortune threat m human life and the envkaninenC or,in am a small quantity saturator.I <br /> m <br /> have ade.good faith So l to mdlmiae my wave generation antl Select the best waste management method that is available to me IMI Ica..Rod. <br /> This individual signing in the space set forth below nn behalf of Cmtornei regeseri s and wauants Ihat he,she has the authority to bind Customer that the forgoing descriptions of waste and matenals are true and accurate <br /> e,-,ors aM laboltd,aT rowdy(wru—,riaMn In Mr n,tlame with applltablx state and federal Iegulatiorm,and that Customer shall ableaha be,bound by the Standard T..,aha Conditions on the IPV¢ISB <br /> Slee of this SNVke Ome, <br /> Customer Signature Date Driver Signature Date <br /> [10nh Namo Print Drivers Name <br />