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mbR SERVICE CALL: SERVICE ORDER <br /> f -800-9744495 ASBURY ENVIRONMENTAL SERVICES , DBA FORM No. WOE5004-A (1 /17) <br /> wOR ACCOUNTING CALL: ;r ; SERVICE ORDER NO, <br /> i62-231 - 1550 F7A <br /> I 'r 3046020 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICEStn <br /> �!• REEVE TRUCKING CO1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> Is <br /> 10646 CALABASH AVE 1 -800-974-4495 PO BOX 5202 <br /> WWW.WORLDOILCORF',COM <br /> EONTANA , CA 92337 TRANSPORTER EPA # CAD028277036 <br /> ' (209) 989 - 1086 STOCKTON , CA 35206 <br /> (209) 981 -1086 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> RI; 5107 FONCSo2 r�3l SCHEDULED. 1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # <br /> 1 /19/2018 1 / 11 !2098 CAL000431860 Z97PART # DESCRIPTION QTY UNIT PRICE QTY PIU r TOTAL <br /> PW PARTS WASHER WASTE - - $ 0. 00 $0, 00PWSC PARTS WASHED SERVICE/RENTAL i $ 0. 00 <br /> FF <br /> BATCH d, <br /> Cr ss Stream; C: �*4jo wi <br /> _ TOTAL <br /> CASH REC'D: CHECK #. Aoaount Manager: Brian Whalen <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 /> —Nt?laI- E C I�A�A(3gS�L15 WAsr r_ Ir l <br /> OTHER: <br /> �rnT�OfLY_1.AATFA) STA T€.00DE_135 <br /> DESIGNATEDTSDF: LIEMENlUC1/KER[14QN 2000 n( ALgMEpA 51"I.F ET, GC711?'( rJl+ , OA R022Z (31U)fi �7� 71 (lq pAT08gg152 <br /> ALTERNATETSDF: -- <br /> DRUMS P/U,* EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that: JAN <br /> ( Waste oil generator/customer MUST check ONE of the following three bo <br /> 7191 ) 1 have not mixed any of tire waste descHbed above with any other hiizardou& wast talhalide c ntentisLESSthan1,p00 ' s • •• • • • " • • . . . . .. . .... <br /> the applicable California used oil management regulations to determine this 15 tr e. l a Y pPnu and the waste does not CMitalnmty PC.II.; vc�ntprlx }vs;tra!#vreryurrrtirccs4avr� " <br /> V g ccepitheaddiuonalcharges (orihedisposalofthisif the informationIhaveprovidedaboutthiswasteisincorrect <br /> Ar <br /> �tl2lhave not mixed anyo( thewaste described above with any other hazardouswaste the total halide content Is GREATER than 1,o0o ppm, and rlea� te does not contain anypCBs. l <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 addltional,charges for the disposal of this <br /> waste If the information I have provided about this waste Is incorrect <br /> /IAP ( ( 3 <br /> �t3) litisvrastclsfinmaranktvirlchco""cLswasteaillromhousehnld `do -it-yourselPfrBY') and/or ccndltfouall exempt small a niti <br /> InrnyUIV/ C'rSC1cnlicctlonum4lssnreylrampiYaitdlorCE5Clczsources litavenotmlredthlswasteollwithan eihrilraz rdtuswasgen rater (CESQG) sources, Tothe best olptyY.nowledge, the only waste oil contained <br /> oftlrlswasiolithelnfr+roai 'nnihaveprovidedabo II svraslelsinrorrEcl qq y te, orwosteallfromot)rarsources. Iagreetoaccepttheadditionalcbargc-sfordispoial <br /> (AII generators/ customers MUST rev`d the following text andleck the associated box.) <br /> el ) I( I am a large quantity generator, I m"I tt stor r have a program in place to reduce the volume <br /> and2exldty oFYraste generaledloihe degree ( have determined to be economically practicable and that 1 have <br /> selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human IHe and the environment; 0, If I am a small quantity generator, I <br /> It made a good faith effort to minimize my waste generation and select the best waste management method that Is available tome that I can afford. <br /> This individual signing In the space set forth below on behalf of Customer represents and warrants that he/she Iles the authority to bind Customer, that the furgaing descriptions of waste and materials are true and accurate <br /> asp aclaqed, marked and labeled, are ready for transportation in accordance with applicable state and federal regulations, and that Customer shall aAAdboundby the standard and Conditions on the reverse <br /> side (ittthis 5etvice i e <br /> Cilsi mel Signa�tur Date <br /> —._�vl, Dr" . er Si'�n�iturc Date <br /> Print Name I riiit Drivers Name <br />