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FOR.SER?K CIII SERVICE ORDER
<br /> PARLIER ASBURY ENVIRONMENTAL TAT SFRVICES, DBA FORM NO_WO"ES004_D f1/17)
<br /> 559-498-02¢0
<br /> SERVICE,ORDLR Nb.
<br /> FOR AGCQ�NTING CALL:
<br /> r �3'` 15507
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<br /> LO OIL
<br /> .:
<br /> 14287 EAST MANNING AVE,PARUER Cry 93648
<br /> 1-559 498-0740
<br /> E WVVW.WORL DOfLCORP.COi1
<br /> TRANS-OPTED EPA 4,CAD0282770'r6
<br /> Cts~ STGlvit ! PURCHAS[ORDER i f ROUTE TRUCK# CONTACT NAME ORC>ER TRKEN BY HALfDES
<br /> i
<br /> ,ATE PEQUIRED GAi E ENTERED NEXT SERVICE DATE CUSTOMER FPA,-'
<br /> BILL of LADING/MANIFEST;
<br /> ».�-----...-'----.-,...,...,. y ..,..`..__ i _. r e f'.A d` P"`, ..� C. ._✓'-'�,fid� [
<br /> ...� __�__ � .�, � �,.,..r` % '4.x3 „� ';r,y $ d � ,r°...ar�,..,,zlt#L.✓
<br /> PART# DESCRIPTION QTY UNITPRICE CITY P/U TOTAL
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<br /> I C
<br /> TOTAL
<br /> ICA51': nEC'Li:_ CHECK# _
<br /> WASTE DISPOSAL iNFtORMAT!0N
<br /> NON-RCRAHAZARDOUS WAS TE,LIQUID 0SEDOIL/MIXED OILS) STATE CODE 221
<br /> NON-RCRA HAZARDOUS WASTE,LIQU1)I.E T HYLENE CLYCOL SOi_U T IOINS` STATE CODE
<br /> 1 E R: _
<br /> DESIIGNATETSDF
<br /> DRU#MS P/U: EMPTY DRUMS:___._ � FACILITY BSC..____
<br /> GENERATOR WASTE CERTIFICATION (PU=RSE CHECK THE APPROPRIATE BOX)
<br /> By 3x4mntd belc,w r htre6y L rti.'y that:
<br /> (Taste oil generator/customer MUST check ONE of the following three boxes)
<br /> OwF,I l i ewe nor Mi-ed any of the' ae,to de t-iE d 1P)u with t o-I-r Nazar- us +auc the tntai nal[i [tent is LES,ih?n 1.609 plum,and-he vasle do=;rut contain any PCBs.i have complied smith the requirements of
<br /> the dpp.icabie fa!}o.,iia aced o'i n.anx�erienr n;tulatr.r,.,tti,tint ,i,11 suis s ruc_fagree to ar cept ,:;inonal cpurge:for%hc di-,peat of il—Nraste If;lie�atorrNation i have provided about chis waste is incorrect
<br /> =42 I liv,not mixer'any vi t`+e,aa,tq dela'oed aro 't n ns 2t1e I. rdau --r t e ri EA ER Thar-r.0")'rprn rod the waste does[tot-contain arty PCBs.I
<br /> have pros idea propar documentation to tinJorkd Ori r'v lnman,,,Serv'c�s to rebr.,r „-. ,; s.:;,:_,I oc,,e•hazardous'waste.l agree to accept the additional charges for the disposal of this
<br /> >das.-:f rhe information I have provided abpril.h',s',vale is'.ncarrecl
<br /> (1111 Wa:iW Is f-om 3 Tank whj,1],rolled'h_i tujl Pm f ocs�lw;W (nly �� - - !r{'.[amity gerlArator KESQGj Sources,To Vie brut of my knowiedge.I only wa$te oil�Onlalned
<br /> In my GIst*If Th e 'eciinn rank is We,from 031 f a d+n CESC',_ r
<br /> fD�.hrom other sources-:agree to accept the additional charges for disposa.hr.aa,tg'F-h�inF�rnlatinn I Nava ahc
<br /> lirrwdec rr trns v:ustr i -.. -
<br /> (Ail generators/ ` the foliowing text and check the associated box.)
<br /> is q qmutdq y- eralio,1 citify that 1 h-.e a progr r -- .J to v:'.i r -stc n-ataJ to•u.1'errAe n've def r iii red to hr ero:rom'caE€y nraciir.al)ie[ard that I have
<br /> selc�i.d Filepractrca@7 me..hnd of treatment c3rrlge -I c ?E arc i try a th ro me uF ch In insmvs rhe p e .nd I'LlWl x rhrear to human Irfe a 0 the environment;Or,if I am a srrraR quantity yene*tor,f
<br /> ha.-n1kde a_noc"fakth effark t9minim]Zp my Waste genereti jr.r,1J s.,per the b-1 waste rna.nager^ertr rtethad[hat's a•fn iVa6le to r.?fiat I can of ord.
<br /> This -r wduc,sryr-- r{�,the_P x se `o th belay-.r 1-1 i of: n r r-o r t lnii w r� s t 't hr'she ),:"r Y e auto-:ity t.rind Cm.omer,Thai the Forgo=r,ra desc:iptions of saastE anis materials are true and ac:urate
<br /> isp 7 g>d,ma 4 dahr.�iabe,..,,ur_:eaaY f,r;ra.hpa ,.r ' r_gulatr;ras.and Thar Ctstolner shall abtdeand be bound by the Strsedar<17rPrTnsand Conditiolns en tate reverse
<br /> ,..'ide. ;Ixy Siary c.
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<br /> Sinatur� Date Drive Sichiatur4 � ° — s'
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<br /> Print Name Print Dri<rerS' ame�
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