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_ SERVICE ORDER
<br /> =..1� ASBURY ENVIRONMENTAL SERVICES, FORM NO.WOLS004-O (1/17)
<br /> SEWCE ORDER NO.
<br /> -50
<br /> ., s
<br /> WORLD
<br /> flr, -, -Ai SF-F"V cFsi
<br /> l i87 EAST MANMNG AVE,PARUER CA 9364 €
<br /> 1-559-498-0240
<br /> 'vWWV lVORLDOIL�;ORP.COM
<br /> TRANSPORTER EPA R CAD0282770.36
<br /> CuSTOnIER PURCHASE.ORDER P,"-?UTE FRUCk T CONTACT NAME CARDER TAKEN QY HAL iDE.S
<br /> 44 f. k
<br /> DATE REQUIRED DATE,EiNITERFL? NEXT SERVICE DATE CUSTOMER EPA BILL of LADING/MANIFEST
<br /> DAR r # DESCRIPTION QTY _ UNIT,P8ICE QTY PIU TOTAL
<br /> 4 N.
<br /> i
<br /> r
<br /> I
<br /> t
<br /> TOTAL
<br /> CASH PEC'D: CHECK f
<br /> WASTE D4SPOSA.L 1NF0RMAT3O1\! I
<br /> NON:-RCRA HAZARDOUS WAST E,LJOUiD I USLD UL/M!XED OILS) STATE CODE 221
<br /> NON-RCRA HAZARDOUS WASTE,Li UID i,E T HYLENE GLYCAL SOLUTIONS) STATE CODE
<br /> OTHER:
<br /> DESIGNATED TSDF: sr•,: .. , r:a a;, ri F, j
<br /> ALFERNATETSDF.
<br /> l
<br /> DRUG"SP/U: _ rVkF r DRUMS: _.. FAME€TY:___. _......----- 2SC _
<br /> GENER,tJOR lNASTE CERTIFICATION(PLFASE CHFCKTHE APPROPRIATE BOX)
<br /> ny hr=_ 'Gereby c�rify tdat:
<br /> -- (Waste all ceneratar/customer, MUST check ONE of the fcllonriE-g three boxes)
<br /> ._ ari" ,r the n.:a.-- r ecce hn rt e.,,.,,:Ar lou h .a�allral j_:1 'r55'Than 7�crpv-a^rithe"Wa:vdo_snoe,rCntau:arryPC.Bs.I hive ctmplied With the requirements of
<br /> '10't° r the inform,:tion.:Pare provided ahout rhi—aste is incorrect
<br /> �Ji: .eve nc. ;> ..,- :. :;,... .. n1r111 ppm,and toe..^:aaie:dues not e01?in any PCBs:i
<br /> '.? j rov.idec Pr-p,_: .._ Urs sv:.,, ❑ine.r haaar:tocs evaste.I aaroo to acupi he additional charge>foi the disposal of this
<br /> „ qua'-'''L- q aaca.tor'CESQC so.rrces Tr.the;ou of my knowledge,the only waste ail contained
<br /> t n.,vr=no:n• ._ t,.:k. Irl:aitl o an, ,;r nazarr3 v5,,,,s to -ste.o�l from utt r cn(jnrces:1 agree to anent the additsonal manges for disposal
<br /> of tnifi VtlaslF� ' _ -: _, lu. .•a==_ r -: _ _
<br /> Cvtcrs/-usi.omers NIU'-,T read the`allovAnrg text and check the associated box.)
<br /> aua 1IAi� i C t: - -v me r:,r t,.,-,;0U':,1 :u.:..n...,,UE'.'e 11d,Ozrcn,c- „>h.-oen—w,,J to the 1•a-dLioi-,wined to be r,d that!hav^
<br /> ktred rhe p€rcncable nrrl hod of c;—m, _ r d-_r::, .I_e fro--ay .:zuf t,-mu'Abid,nTirrimi7es ti,a 3. _en;arid M.wr th-eat to hu;ran hfe anc!the erivironmPnt:Or.if I am a smafl quantity generator,:
<br /> have rnadea poor faith effor'o-narrmt_e -� ,erarion a,c«ICCr N i�L,s:caste manaa2ril nm vethr,d that is ave:,lal?le m enc rh3t I'-2n aPr?ed.
<br /> This-i.-dual.ianin}it thes�,r:Ce se'nor[1.�-. ,:-h if 51 CL11111:1'.-.; ti-.r,ts r,nd ..,runes t.a,n.;,,e-:;ls m au[ne'�aty n:b.�d--cstomes,that the forgcinq eiescriptions of waste and materials-are true ai,d accurate
<br /> as r,ccKaned marker?and kabelect.are reanv for t,ar,spo,ma6,, , _win,zn:. _ h.,r I?;i..0- r:;-�n I _'er,i-re a-.-_ns,;mn tkat Customer shall abide and be bound by[he Standard Terms ane Cwdidon5 on the reverse
<br /> -sic, <his service O',Jer _ .
<br /> ,
<br /> e
<br /> ,Custorner Signature Date 01 wer Signatrare gate
<br /> Print Name
<br /> Print Drivers Na fYe
<br />
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