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FOR SERVICE cALI_: SERVICI ' RDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> 559-498-0240 ; <br /> SERVICE ORDER NO. f <br /> FOR ACCOUNTING CALL: lltf�'a 1111 i N25,96`194 <br /> ,. <br /> 562-231-1550I `I ) <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> 1 <br /> H. F 1h�1=S ONE 4435 01 14287 EAST MANNING AVE,PARLIER CA 93648 �.l (l ��' f SOURCE l�it(,�l t- IMI �. <br /> P. 940 N, �'IMN`�y r4tf,.. l`4�1v 1-559-498-0240 .61 5 MAINS,: TR�.E'r, 6UI��o 4r� 1 <br /> P W1NW.WORLDOIL'CORP.COM' 1 <br /> IWACY,GA 95370TRANSPORTER EPA#CAD028277036 72) 4644,3004. <br /> 1 5 °T 73G3� <br /> 0 '21-7104 <br /> ( <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> I IRfi S <br /> ROUTE 11f:) t�f � MARGf,L SC61I:-DUl f D-1 s . j <br /> i <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 612V2018 6Y 1412 0111 CAL000370390 <br /> (161)G v T <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U; TOTAL ' <br /> li`fftOS k1L��D.01L SERVICE CHAT d�f 1 <br /> WoUSED(JN..f tUlif:Iai OILS:: <br /> € PEiN M F' •1E�WI�A''i 7-4SP��,S,�1.N W511M IAT, *,�. � z <br /> - 1 <br /> i <br /> TOTAL <br /> &fBtfUfi 1�6'l�f��r: 167dt #itlrlX <br /> I. CASH RECD: CHECK# <br /> I. <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) STATECODE <br /> i <br /> OTHER- <br /> DESIGNATED TSDF: <br /> THER:DESIGNATEDTSDF. A•SS§�t�RY ENIVI �f� WT'A� IE I I a 'i o moRoAN Rci. RES,CA.96 ( )54?�1 , A q C� € f1.' I <br /> ALTERNATE TSDF: <br /> A <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC f <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/custome.r.'MU"ST check ONE of the following"three boxes) <br /> #1)I have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than1,000 ppm,and the waste does not contain-anyPCBs.I have complied with the requirements of ! <br /> e 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 I <br /> p#21 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 the resumption.that this waste Was mixed with other hazardous waste.I agre to accept the additional charges forthe disposal ofthis <br /> waste if the information I have provided about this waste is incorrect - <br /> D 93)This'waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained <br /> in my DIY/CESQG collection tank issoley from DIV 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 if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) t <br /> #4)If I am a large quantity generator,I certify that I have a program m place to reduce the volume and toxic ty of waste generated to the,degre•e I have determined to be economically practicable and that I have i <br /> - ected-the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment Or,•if I am a small quantity.generator,I <br /> have 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 andwarrantsthat he/she has the authority to bind Customer,that the forgoing descriptions of waste and materials are true and accurate <br /> as packaged;, a kedandlabeled,are ready for transpor .ond accordance with applicable state and federal.regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse- 1 <br /> side ofts Ser Order. <br /> Custo , P gnature Date Driversignatu e ' )� Date is <br /> Prin ame Print Drivers Name' <br />