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FOR SERVICE CALL: <br />SERVICE ORDER <br />FORM NO.WOES004-D iPAROER <br />559-498-0240 <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />SERVICE ORDERNO, <br />FOR ACCOUNTING CALL: <br />�..._ 562-231-1550 <br />WORLD OIL <br />ENVIRONMENTAL <br />SERVICES -14287 <br />EAST MANNING AVE, PARLIER CA 93648 <br />,. , •I <br />1-559-498-0240 <br />t <br />WWW,WORLDOILCORP.COM <br />o <br />0 <br />TRANSPORTER EPA # CAD028277036 <br />; <br />TAKEN BY HALIDES <br />' <br />CUSTOMER # <br />PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME <br />ORDER <br />DATE REQLIIRED <br />DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # <br />BILL of LADING/MANIFEST # <br />`0 <br />QTY <br />UNIT PRICE QTY P/U TOTAL <br />> <br />PART # <br />DESCRIPTION <br />_ <br />J <br />D <br />C <br />M <br />(D <br />%ir <br />TOTAL <br />�A�D: <br />CHECK # <br />WASTE DISPOSAL INFORMATION <br />� <br />STATE CODE 221 <br />NON-I4CRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) <br />NON-1 <br />ODE_ <br />STATE CODE— <br />; <br />WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />NON-RCRA HAZARDOUS <br />OTHER: <br />DESIGNATED TSDE: <br />ALTERNATE TSDF: <br />EMPTY DRUMS: FACILITY: BSC <br />— <br />DRUMS P/U: <br />(PLEASE CHECKTHE APPROPRIATE <br />BOX) <br />GENERATOR WASTE CERTIFICATION <br />By signing below I hereby certify that: 1 <br />(Waste oil generator/customer MUST check ONE oft dt folio' e waste does not ohtaeein nboe boxes) <br />complied with the requirements of <br />,,lz 1 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 [o determine this is [rue.lagree to accept the additional charges for the disposal of this waste if the information lhave provided about this waste is incorrect <br />CBs. I <br />Dat I have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 1,000 ppm, and the waste does not contain any additional <br />have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.) agree to accept the aadditional charges for the disposal of this <br />waste if the information I have provided about this waste is incorrect <br />sole from DIY and from <br />CESQG sources. I have not mixed this waste ll with any other hazardous waste or waste oil from other s=013) This waste is from a tankank Ish collects waste oil from household "do -It -yourself" (DIYI and/or condurces. ) agree to accept the additional charges for disposal <br />Qitionally exempt small quantity generator (CESQG) sources.To the best of my knowledge: the only waste oil contain <br />vh1c <br />in my DIY/ CESQG collection t <br />of this waste if the information I have provided about this waste is incorrect ..1 <br />(All generators/ cusomeUseMUST the eread the follotoxicity of waste generated text and ee Icheck the dto beeconomically pprra citable and that l have <br />Qq4) if I am a large quantity generator, I certify that have a program in place <br />waste gen and select the best waste management method that Is available to me that I can afford. in descriptions of waste and materials are true and accurate <br />selected the practicable method of treatment, storage, have <br />disposal currently available to me which minimizes the present and future threat to human life and the environment; 01, if I am a small quantity generator, <br />have made a good faith effort to minimize my 9 <br />mThis individual signing in the space set. forth, below on behalf of Customer represents and warrants that he/ has the authority to bind Customer, thatthea forgoing p <br />1 atka ed, marked and labeled;;afgready (Of 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 />ode of this Service Order. <br />Date <br />Customer Signature <br />Print Name <br />Driver Signature <br />Print Drivers Name <br />I__ - <br />Date <br />711 CM Receipt 6.11.18 <br />