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RECEIVED BY SJCEHD (EF) on 2/21/2020 <br />FOR SERVICE CALL: <br />SERVICE ORDER <br />PARCIER <br />559-498-0240 <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />'OR ACCOUNTING CALL: <br />562-231-15507-75500 <br />WORLD OIL <br />s <br />ENVIRONMENTAL SERVICES,, <br />H <br />1 <br />14287 EAST MANNING AVE, PARLIER CA 93648 <br />P - <br />P <br />1-559-498-0240 <br />Ii 1 'i , ! i . i, I <br />WWW.WORLDOILCORP.COM <br />T <br />0 <br />TRANSPORTER EPA # CAD028277036 <br />CUSTOMER# I PURCHASE ORDER *t ROUTE# TRUCK# <br />REQUIRED DATE ENTERED <br />NAME <br />1, <br />NEXT SERVICE DATE CUSTOMER EPA ti <br />,1 <br />FORM NO.WOES004-O (1f17) <br />SERVICE ORDER NO. <br />I1.'_._...; , <br />II <br />Gri'JUI I <br />201E �]Rc�HAi=;u �t <br />I rkwuni�,�tT,:�r'a, II_f <br />ORDERTAKEN BY I HALIDES <br />f BILL of LADING/MANIFEST # <br />PART # DESCRIPTION QTY I UNIT PKIl-t l r 11u <br />TOTAL <br />REC'D: CHECK # <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br />OTHER: <br />DESIGNATEDTSDF:i^Dt#' DI tG^f S)':f.7d. l70"1ri9;i oti!1R. C;^1"i]d1?.dL2 <br />ALTERNATE TSDF: <br />DRUMS P/U: <br />EMPTY DRUMS: FACILITY: BSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />r <br />ME- <br />By signing below I hereby certify that: - <br />(Waste oil generator/customer MUST check ONE of nddt follohe waste wing boxes) not chraeein nhave complied with the requirements of <br />r�all_I have not mixed any of the waste described above with any other hazardous waste, the total halide content Is LESS than 1,000 pp <br />—the applicable California used oil management regulations to determine this Is [rue.l agree to accept the additional charges for the disposal of this waste if the Information 1 have provided about this waste is incorrect <br />Q#21 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 1,000 ppm, Slid the waste does not contain any PCBs.I <br />have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this <br />waste if the Information I have provided about this waste is incorrect <br />tsmall quantity re(best f <br />my knowledge, the onlywasle oil contained <br />O tank <br />h collects waste oil rom oushldevrseDand/orco exem <br />11 fom other sourrcese agreeto a ept the add t onal charges for disposal <br />in m DIY/ CESOG cole n coley from DY and o CEoree. I hae nIxed oil whhotherhazardous waste or generator <br />of this waste <br />ff 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 />O #4TIf 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 6e economically )alpracticable and that 1 have <br />have made a good Fath a le method <br />minimize ie my waste generation tment, storage, or losal currently select the available <br />t blwa�te ma ,agementme which nmethod izes the hat snavailable to met and future thatI can afforeat to human de and the environment; Or, if I am a small quantity generator, t <br />cted the <br />tions of waste and <br />ale <br />ue and <br />te <br />lie/she has <br />ity to <br />Customer, that <br />indfvfdual signing <br />ndthe <br />labe ed, are ready fobelow <br />tranosportatiobehalf <br />n m accordance with applicable rstate and rants tfede al regulations, and that Customer shall abldehandrbeibound byPhe Standard Terms andConsditoos on the reverse <br />of <br />marked <br />of this Service Order. <br />Driver Signature Date <br />Ok Customer Signature Date <br />Print Name <br />Print Drivers Name <br />711 CM Receipt 5.25.18 <br />