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FOft SERVICE CACI.: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL. SERVICES, DBA FORM N0. WOES004-D (1 /17) <br /> 559-49$- 0240 WO 300 SfRVICRDER N0,FORACCOUNTING CALL: WODIY ,562-231 - 1550 N00 <br /> AF 110 <br /> WORLD I <br /> ENVIRONMENTAL SERVICEStM <br /> H REEVE TRUCKING • REE008 14287 EAST MANNING AVE, PARLIER CA 93648 <br /> P 5050 CARPENTER RD 1 -559-498-0240 PO BOX 5202 <br /> E WWW,WORLDOILCORRCOM <br /> T STOCKTON , CA 95?_ � 5 TRANSPORTER EPA # CAD028277036 STOCKTON , CA 95205 <br /> o (209) 940-2623 (209) 950-2623 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> REEQgB CER• 86 DAVE squintana <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST <br /> 4119/201 $ CAL000333052 �. -. �7 <br /> C .. <br /> 0)1 <br /> PART # DESCRIPTION QTY UNITPRICE QTYP/U TOTAL <br /> PW PARTS WASHER WASTE 0 <br /> 0 0 qQ <br /> 30 $0. <br /> PWSC PARTS WASHER SERVICE CHARGE 1 $ 40 QO $ o 79 85 <br /> l <br /> LOCATED N BOSS'S SHOPII PLZ SEE DAVEII BATCH +F <br /> Crops Streets, <br /> TOTAL <br /> CASH REC'D: CHECK # Account Manager: Steve Gately <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> " OTHER: _=,,LR"A+-1, gDMS WAST(-4 .l*lQtJfD1 (OIL."IATER)_.._W ATE�JDE135 <br /> DESIGNATEDTSDF: �DENNO/ d00F.f3A sTfiEET; QMPTFyN; <br /> ALTERNATETSDF; <br /> DRUMS P/U: ' . EMPTY DRUMS: FACILITY: BSC ti'� ti T i s, ' <br /> - 1 { o I .) <br /> n , _ <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) � . y �<• � � (J j )j <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three'b0"6K) _ r <br /> "714 1) I have not mixed any of the waste described above with any other hazardous waste, the total halide content Is I,M than 1,000 ppm, and the waste does not contain any PCBs. I have compiled 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 this waste if the Information I have provided about thiswaste is Incorrect <br /> =021 have not mixed any of the waste described above with any other 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 Oil Environmental Services to rebut thepresumption that this waste was mixed with other hazardous waste. ) agree to accept the additional charges for the dlsposai of this <br /> waste If the information I have provided about this waste is Incorrect <br /> =1113) 1 his waste is from a tank which collects waste oil from household 'do,it>yourself` (Oly) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my knowledge, the only waste oil contained <br /> In my ON CESQG collection tank is soley from ON and/or CESQG sources. ) have hot mixed this waste Olt with any other hazardous waste or waste oil from other sources. I agree to accept the additional charges for disposal <br /> of this waste if the Information I have provided about this waste is Incorrect <br /> 4 (ATI generators/ ct.lstomers MUST re0d the following text and check the associated box .) <br /> 11+4} If i ,un a Large quantity rleriela)1 ; I cel <br /> ,if <br /> that I I><3ve a pfpgram to place In reduce the ynlunsr• arid fuxktly fit wh>tr genetat d to ilia dayrce I have detenllilir_ti to bc� . 1 ii i <br /> s, Gdedtheplacticablenielhodoflreatmepl, sterage, ordfspto ,jltoile ttyAvailable inmewhich mVnimizasthe ltesentehdfukne r it coat t, . ntcyllyltmcticiltieandd1a1111.ive <br /> hast rade a 9oodfalliIt(foo to minimize my waste generation anit gVIeci the best waste mnlagenient methal tliat h avaAable to min IIat IraII ffmloe and lheenvhnslmnnt; Oft it l fill small quarruly gent>atoi, l <br /> Tfrkr uufividuaI si nnrlg bl the silo cc set for below on behalf of Customet represents and War(arhis that Po .1she Isar 1110 authority to I+iIid Customet, Iat the foruoing de%tiptiors of waste and mate ria is are I, up <br /> oda ccurate <br /> si e of t gad. •narked and Inbdled, ale randy for transpoual ton 3s arco+dance gvil h applicable stale and lederaf regubn ions, andt Y of 6ttslomer shall aU1de and br- bound by the 5lantlard Teens and Conditions on the rr:vnrse <br /> sidcoflhisS vice0rder. <br /> . : <br /> ✓✓ <br /> M _ /— /_ — <br /> Custam Ti'Signat �f Date -- -- — — <br /> Drive4ite Date <br /> Print Name Print Drivers Name <br />