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FOR SERVICE CALL; <br />PARLIE'R <br />559-49,9-0240 <br />f <br />FOR ACCOUNTING CALL: <br />556`2-231-1550 <br />s <br />p Vdl <br />E <br />D <br />T <br />0 <br />177 <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />0 <br />WORLD OIL <br />ENVIRONMENTAL SERVICES.- <br />14287 EAST MANNING AVE, PARLIER CA 93648 <br />1-559-498-0240 <br />W W W. W ORLDOI LCORP.COM <br />TRANSPORTER EPA # CAD028277036 <br />CUSTOMER # PURCHASE ORDER # ROUTE If TRUCK If CONTACT NAME <br />SERVICE ORDER NO. <br />)ATE REQUIRED DATE ENTERED NEXT SERVICE DATE <br />CUSTOMER EPA # <br />�i7, d/�dLOlf1 <br />1�:�1C)ptl.+i!3:'Ct�IS <br />PART I <br />FORM NO. WOES004-D (1/17) <br />SERVICE ORDER NO. <br />n <br />1'FIE_ E.G GROUP <br />2011 E. ORCHARD ST <br />HAI.IFlIE'ri lTf�hl, NJ 08W37 <br />ORDERTAKEN BY HALIDES <br />BILL of LADING/MANIFEST If <br />UNIT PRICE QTY P/U TOTAL <br />D <br />D <br />D <br />D <br />TOTAL <br />I SH REC'D: CHECK # <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/NIIXED OILS) STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br />OTHER: <br />DESIGNATEDTSDF: <br />ALTERNATE TSDF: <br />DRUMS P/lJ: <br />EMPTY DRUMS: FACILITY: BSC <br />[-- <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />By signing belov+ I hereby certify that II <br />te oil generator/customer MUST check ONE of the following three boxes) <br />(Wasm, and the wasteoes the � <br />tithe applicable California used oil waste managementregulauo sd above lth any other to determine this is true. lus 3agree to accste, the leptithe additlonide content lal charges s LESS lforthe di00 sposal of this waste f the not <br />l have provaded about hlswste is Incorrect <br />requirements o II <br />Oq2 I have not mixed any of the waste described above with any other hazardous waste, the total halide content Is GREATER than l,000 ppm, and the waste does not contain any PCBs.I i <br />the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this <br />have provided proper documentation to World Oil Environmental Services to rebut <br />waste if the information I have provided about this waste Is incorrect <br />tator <br />best <br />my <br />nally <br />small quantity <br />+ n m This waste G from a tank o k is soley from DIY anlfrom household d/or CESOG sources, I have not mixed thi-it-yourselP (01Y) s /or waste oil with any otherrh hazardous waste drew ste(oEf om others urrcese agreerto accept the additional chargeORIY waste sfor dlspil losal <br />In my DIV/ CESOG collection <br />of this waste If the information I have provided about this waste is incorrect <br />(All generators/ customers MUST read the following text and check the associated box.) <br />practicable n method Oftreatment, storage, have <br />disposal currently available to me which minimizes the present and future threat to human life and the environment, Or, If 1 am a small quantity generator, l <br />j�#4) If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have <br />selected the prat[ <br />have made a good faith effort to minimize my waste generation and select the bestwaste management method that is available to me that I can afford. <br />of <br />re read for transportation In accordance with applicable state and federal regulations, and that Customer shall abide and be bound by the StandardTerms and Conditions on the reverse <br />This individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer, that the forgoing descriptionsanwaste and materials are true and accurate <br />l <br />acka is S marked and labeled, a Y of this Service Order. <br />_�-)- <br />/ / Driver Signature Dace <br />Customer Signature <br />Date <br />- Print Drivers Name <br />Print Name <br />711 CM Receipt 4.27.18 <br />