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RECEIVED BY SJCEHD (EF) on 2/21/2020 <br />FOR SERVICE CALL: <br />SERVICE ORDER <br />FORM NO. WOES004-D (1/17) <br />PARLIER <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />SERVICE ORDER NO. <br />559-498-0240 <br />FOR ACCOUNT/NG CALL: ! <br />2-231-1550 <br />562-231-1550 <br />WORLD OIL <br />is - <br />ENVIRONMENTAL SERVICES.- <br />5 <br />H j! <br />14287 EAST MANNING AVE, PARLIER CA 93648 <br />y <br />P <br />1-559-498-0240 <br />'," r', ; -• i �... - <br />U <br />P <br />E <br />WWW.WORLDOILCORP.COM <br />r .,_ ,�. t <br />D <br />o <br />TRANSPORTER EPA # CAD028277036 <br />CONTACT NAME <br />ORDERTAKEN BY HALIDES <br />CUSTOMER # PURCHASE ORDER # <br />ROUTE # TRUCK # <br />_)au,l__flI <br />BILL of LADING/MANIFEST # <br />DATE REQUIRED DATE ENTERED <br />NEXT SERVICE DATE CUSTOMER EPA # <br />QTY <br />UNIT PRICE QTY P/U TOTAL <br />PART # DESCRIPTION <br />D <br />TOTAL <br />WASH REC'D: CHECK# <br />WASTE DISPOSAL INFORMATION <br />STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE_ <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />OTHER: r y _„•.. ;:r <br />DESIGNATEDTSDF: :(rstE PM!t'V'Wk *''Al is ”' VIP, <br />ALTERNATE TSDF: <br />DRUMS P/U: EMPTY DRUMS: <br />FACILITY: BSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />-) By signing below l hereby certify that <br />! (Waste oil generator/customer MUST check ONE of the <br />follothe waste wing s not three boxes)nve complied with the requirements of <br />i h I) I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS charges <br />r the pp <br />the applicable California used oil management regulations to determine this is true. I agree to accept the additional charges for the disposal of this waste if the Information 1 have provided about this waste is Incorrect <br />ER <br />the <br />CBs. I <br />Q#2l have not mixed any of the waste described above with any other hazardous waste, thsumpte total on that <br />t thiscontwant ste <br />was mixed th of ppm, ardour waste doesnott accept <br />additi <br />have provided proper documentation to World Oil Enviro i meCotar cetrvices to rebut the presumption that this waste was mixed with other hazardous waste.) agree to accept the additional charges for the disposal of this <br />waste if the information I have provided about this waste sin <br />ed <br />tank is Soley from DIY and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.) agree to accept the additional charges for disposal <br />O#3) This waste is from a tank which collects waste oil from household "do -It -yourself" (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. ur the best of my accept <br />a the only waste oil t disP s <br />in my DIY/ CESQG 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 />p#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 1 have <br />selected the practicable method of treatment, <br />nt, storage, <br />e, Or disposneration al <br />currently seect the available <br />torte a which <br />managementize meth thats the snavai able to met and future thatI can afforeat to human 1d. and the environment; Or, if 1 am a small quantity generator, ) <br />have made a good faith effort to min Y <br />for transportation in accordance with applicable state and federal regulations, and that Cusms and Co <br />tomer shall abide and be bound by the Standard7ernditions on the reverse <br />is individual signing in the space set fordth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer, that the forgoing descriptions of waste and materials are true n t accurate <br />c,ackaged, marked and labeled, are ready 9e of this Service Order. e. <br />r° <br />Driver Signature Date <br />Customer Signature Date <br />Print Drivers Name <br />Print Name <br />711 CM Receipt 6.15.18 <br />