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FOR SERVICE CALIII SERVICE ORDER PARLIER WO 300 ASBURY ENVIRONMENTAL SERVICES, DBA FORM N04 WOES004-D (1 /17) 559-498-0240 - FOR ACCOUNTING CALL; W®DIY SERVICE ORDER NO. 562-231 - 1560 AF 110 0 N2W4200 WORLD OIL 5 REEVE TRUCKING - RE ENVIRONMENTAL SERVICES,M H SM CARPENTER RD 14287 EAST MANNING AVE, PARLIER CA 93648 1 -559-498-0240 PO BOX 6202 D STOCKTON, CA 95215 WWW.WORLDOILCORP. COM STUCKTCIN , CA 95205 TT ( TRANSPORTER EPA # CAD028277036 C 5 MER # PURCHA E ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST Y dnj q& ! 5q '� PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL PAW PARTS WASHER SERVICE CHARGE �Y $125. 125.00 BATCH 0 C TOTAL CASH REC'D: CHECK # WASTE DISPOSAL INFORMATION NOWRCRA HAZARDOUS WASTE, LIQUID ( USED OIUMIXED OILS) STATE CODE 221 NON RCR L�1ca0lf wek RP*ATE =E 223 STATE CODE OTHER: 1 DE5IGNATED 'fSDF: _ E 5TR E TLS , Cp1,�PTd +I, { )✓37.71 , t6 LfERNATETSDF: DRUMS PIU: EMPTY DRUMS; FACILITY: BSC EIVE By signing below I hereby certify that' GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) MAY �. 5 2011 '.. (Waste oil generator/customer MUST check ONE of the following three boxes) BY: Grit ) I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than t,o(to ppm, and the waste does not contain any PCBs. ) have ( nrp i . %I i tlie, requirements of 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 I have provided about this waste Is incorrect '.. O42 I have not mixed any of the waste described above with any other hazardous waste, the total halide content Is GREATER than 1 ,00D ppm, and the waste does not contain any PCBs, I have provided prope( documentatlon to World oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. ) agree to accept the additlonal charges for the disposal of this waste if the information I have provided about this waste is incorrect M13) This waste is from a tank which cojiects waste oil from household 'dodt-yourself" (DIY) and/or conditionally exempt small quantity generator (CESQG) sources, To the best of my knowledge, the only waste Mi contained 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 of this waste if the Information 1 have provided about this waste Is incorrect (All generators/ CUStorners MUST read the following text and check the associated box,) 14) It I am a Wga quantity generator. I s eriify that I hava a inegram in place to reduce the volunstr and toxldly of waste generated to the degree I have desermtned to be economically practicable and that I have fe h macled the practicable method oflrears7e. w.tmeni, ttof dist offal currently available to me which ndnirI the presont and future threat to human life and theenvironmenh m small or, if l aa all quantic generator, I Xde. a good faith e(I to trunimhe my wast* generation and select the best waste management method that is available to me that I can afford, y ' This individual signing In the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer, that the forgirhig descriptions of waste and materials are true and accurate as packaged, marked and labeled, are ready for transportation In accordance with applicable state and federal regulations, and that Customer shall abide ant e ' iund by the Standard Terms and Conditions on the reverse side of this Service Order ZZ /�(D5/jC ' O _ , C Cu omerSignature Date Dliv Si ha ate Print lama _. _ _ Print nrivarc Qiarrsp