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FOR SERVICE CALL: StKVIC t UKUkK <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES , DBA FORM NO. WOES004 - D (1 /17) <br /> 559498-0240 WO 300 <br /> SERVICE ORDER NO, <br /> FOR ACCOUNTING CALL: WOL7IY �z .m <br /> 562-231 - 1550 N2562599 <br /> AF 110 <br /> WORLD OIL <br /> 5 ENVIRONMENTAL SERVICESrrr <br /> H REEVE TRUCKING - REE008 14287 EAST MANNING AVE, PARLIER CA 93648 <br /> P 5050 CARPENTER RD 1 -559-498-0240 <br /> D WWW.WORLDOILCORF'. COM PG BOX 5202 <br /> T STOCKTON , CA 95215 TRANSPORTER EPA # CAD028277036 ST{JCKTON , CA 95205 <br /> D (209) 940-2623 <br /> (209) 940-2623 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # <br /> TRUCI< #E, 40, CONTACT NAME ORDER'TAKEN BY HALIDES <br /> REEO08 CER-86 <br /> DAVE squintana <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA It BILL of LADING/MANIFEST # <br /> 4/19/2018 CAL000333052 7 f" � � <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> PW PARTS WASHER WASTE & $O. bO <br /> PWSC PARTS WASHER SERVICE CHARGE 1 $ 165400 �—� $0. 00 <br /> $ 1179.790 <br /> 85 <br /> PLZ TAKE NEW BRUSH AS WELL, SEE DAVEII BATCH # � <br /> Cr +s Streets, <br /> TOTAL <br /> CASH RECD: CHECK #. Account Manager Steve Gately <br /> WASTE DISPOSAL INFORMATION <br /> NOWRCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: -A!OT�_jiCl'�4 tAZ RUOUS-WA.a1:C,-LLquD4L71Ly–WATER)—;iTATE,.GC QC_19,G_ <br /> DESIGNATED TSDR <br /> AITERNATETS01 OCT1fitNfiVC7lKtRi36t N CjtJtlN tiL7t�li~C IRfi T�t:OM13t 7tr01 902 �;�( 0)5 ;7„'ttUO lTg81�Q13352 <br /> DRUMS Pluf EMPTY DRUMS: FACILITY:- + 17, n --- <br /> v.A <br /> Bysigning below lhereby certifytha <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE B X) x r <br /> ( Waste oilgenerator/customer MUST check ONE of the followingth ►'ee bLiyes- • . . . . . <br /> L kt) Ihave 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 compliedwith the requlramenis of <br /> the applicable California used oil management regulations to determine this 1s true, I agree to accept the additional charges for the dispose I of this waste If the information I have provided about tills waste Is incorrect <br /> r 1921 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 100 ppm, and the waste does not contain any PCBs. I <br /> have provided proper documentation to world oil 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 thisvraste, Is Incorrect <br /> CIO) This waste is from a tank which collects waste oil from household "do•It-yourselfI (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best or my knowledge, the only waste oil contained <br /> in my DIY/ CESQG collection tank is soley from DIYand/or CESQG sources I have not mixed this waste off with any other hazardous waste or waste oil from other sources, I agree to accept the addillonaI charges for disposal <br /> of this waste if the informatlon I have provided about this waste is incorrect <br /> (All generators/ custorner•s MUST react the following text and check the associated box.) <br /> K4) [( I7" let <br /> gequant ty g vert 1, Ic=rtlfy that l have a piugrzm In plain to leducelhr vshlmc anti tonicity ,f waste generated to tlirdcgree l havedetrrmined iu be economically <br /> ecce-d the practicable method ofimluuent, storage, ofdhpo_ al (uuuulyavatabtclomewhithminimizes the Inmeutandfllurethreat tohuman life rid the envuoninent; pasmaableanitygenthat I havc <br /> lint , made a good fact) effort to minirn)2@ my waste generation and setn[t the Lost WaStC Ial JilagCmclll ntethad that 15 nvalhihf€r to me that I call affod, 11elit. Df, If I ani a 41na)l quatjtily generator, <br /> 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 forgoing descriptions of waste and materials are true and accurate <br /> as packaged, marked and labeled, are ready for transportation in accordance with applicable state and federal regulations, and that Customer shall abide and be bound by the 5tandarclTerms and Conditions on the reverse <br /> side of this service order. <br /> C Is timer Signature Date <br /> Driver Slgnat Date <br /> / � n ` . . ,. <br /> Print Name <br /> Print iv rs r e <br />