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FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER AS13URY ENVIRONMENTAL SERVICES, DSA FORM NO, WOES004-D (1/17) <br /> 559-498-0240 WO 300 SERVICE ORDERNo, <br /> FOR ACCOUNTING CALL: WODIY <br /> 562-23111550 N2410656 <br /> AF 110 <br /> WORLD OILV <br /> s <br /> ENVIRONMENTAL SERVICESTM <br /> " REEVE TRUCKING - REE008 14287 EAST MANNING AVE, PARLIER CA 93648 <br /> P 5050 CARPENTER RD ' 1 -559-498-0240 <br /> E WWW.WORLDOILCORROOM PO BOX 5202 <br /> D <br /> N , <br /> STOCKTOCA 95215 TRANSPORTER EPA # CAD028277036(209) 940-2623 STQCKTON, CA 95205 <br /> (209) 940-2623 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAMEIIIItttttt ORDER TAKEN BY HALIDES <br /> REE008 86 i� SCHEDULED- ) <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # <br /> 7/2812017 7/28/2017 CAL000333052 <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> PW PARTS WASHER WASTE 30 $0600 . 4b $0, Q0 <br /> PWSC PARTS WASHER SERVICE/RENTAL 1 $ 125000 ( $ 136. 25 <br /> BATCH A <br /> Croll3s Streets: <br /> ' TOTAL <br /> CASH RECD: 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 135 <br /> OTHER: . —NON- ORA-HAZARD4115-WASTE,-L4QtjID4-41L:Y WATER)ST•ATEOat —1 5 <br /> SIGNATED TSDr: -- <br /> ALTERNATE• TSDF: - --DENNCy7IERDCI�7N; 0CIQN �,;L7)i1VfEDR 5 fRE1 +NC3FVi1*1 OTS;Cp ftUZ22; (310)5377IQ0AI pe�0i3352 ---- <br /> DRUMS P/U: EMPTY DRUMS: F""AGILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that! <br /> ( Waste oil generator/customer MUST check ONE of the following three boxes) ?(SII' <br /> OM1) I have not mixed any of the waste described above with any other hazardous waste, the total halide content Is LESS than 1,000 ppm, and the waste does not contain any PCBs. I have complied with the requirements of <br /> the applicable California used oil management regulations to determine this is true. I agree to accept the additional charges for the disposal of ihis waste If the Information i have provide i about this waste Is quireme <br /> OMz I have not mixed anyof the waste described above with anyother hazardous waste, the total halide content Is GREATER than 1 ,000 ppm, and the waste does not contain any PCBs. I <br /> have provided proper documentation to World 011 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 tills waste is Incorrect <br /> O013) This waste is from a tank which collects waste oil from household "do-It•yourself" (DIY) and/or condltionally exempt small quantity generator (CESQG) sources.To the best of my knowledge, the only waste oil contained <br /> In my DIY/ CESQG collection 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. I agree to accept the additional charges for disposal <br /> of this waste lithe Information I have provided about this waste is incorrect <br /> (All generators/ customers MUST read the following text and check the associated box.) <br /> 1aa) If I am n large quantity generator, l cerilly that I have a program In place to reduce the voiwrie anti for l6lty of waste generated to the de jive I have determined to be economically pracil"ble anti that I have <br /> "elected the Practicable method of treatment: storage, or disposal currently avalioble to me which minimizes the present and future threat to human life end 'the environntam; or, III am a stgall quantity generator, I <br /> have made agood faith effort to minimize my waste generation and select the best waste management method that Is available to me that Ican afford. <br /> This Individual slgnlog in the space set forth 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 and accurate <br /> as P1ckA9vd4 malked and labelud, are ruady for transportation in accordance with applicable state and federal regulations, and that customer shall abld I tbebound bythe Standard TermsandConditions onthe reverse <br /> side of this Service er; <br /> CuU ner Signature Date <br /> D vel Mgf atul P ate <br /> IT <br /> —,(tv <br /> Print Name <br /> I f t Drivers Name <br />