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FOR SERVICE CALL: SERVICE DRDEf� ' j PARLIER ASBURY ENVIRONMENTAL SERVICES, ®BA FORM N0.WOE"s004-D (1/17) 559-498-0240 SERVICE ORDER NO. f FOR ACCOUNTING CALL: 11ta`ODI " '{ N ? I 562-231-1550 AF 100 W011-LD OIL ENVIRONMENTAL SERVICES,-,, ,::I.,. t' 5 I IR '�°x;l•'�.,�E;.i� .5'5681� 14287 EAST MANNING AVE,PARLIER CA 93648 �� `��„ a� �� ;�:I��(M M'I I"IRI 0 I IV.: C kziNTlr�l,�;tI� .. ,: 1-559-498 0240 `I'7 MAIN TR I,T, aQ�il`Iff . . P WWW.WOR OILCORF'COM D: �'I /�c ,C> § 7 - FRI, TX 73034 TRANSPORTER EPA#CAD028277036 T P09), 221-7104 ( '��?) 44 �00 ;, 'r CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES'' I F 'araw ! 1 iii > 20 I �. DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# ! r Jilt PART# DESCRIPTION QTY UNIT PRICE QTY P/ TOTAL OIC N MSI= '.7PM S.AT 1',6PPd SUFI 9-15IR&I RAT8:1•I:0 i cro i ti 81;reef ;. TOTAL CASH RECD; CHECK# I WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS).. STATE CODE DESIGNATED TSDF: A BOKY EWIRMIME E-RVICFx-CERES,1920 MORGAN RD.,CERES CA 95358(2091541-106,6�Lommao I ALTERNATE TSDF: DRUMS P/U: EMPTY DRUMS: FACILITY: BSC f GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) i i I By.signing below Ihereby certify,that: : - (Wasteoil generator/customer MUST,check ONE of the following three boxes) k1)1 have 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 complied with the 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 ifthe:information I have provided about this waste is.incorrect (�#2 1 have not mixed anyof the waste described above with any other hazardous waste,.the total halide content is GREATER than 1,00P ppm,and the waste does not contain any PCBs.I n have provided.proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixedwith otherhazardous waste.)agree,to accept the additional charges for the disposal of this ` -waste if the information I have provided about this waste is incorrect O#3)This waste is from a tank which collects waste oil from household"do-it-ourself"(DIY)and/or conditional l exem t small:qua ntitYgenerator(CESQG)sources.To the bestofmy knowled e,the only waste oil contained 1. 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 fordisposal Yd ste if the info. ation I have provided about this waste is incorrect - (All generators/customers MUST read the following text and check the associated"box.) alar quantity generator,.certify thatI have a program in place to reduce the volume and toxicity of waste generated to the degree I have.determined to be economically practicable and that I have ' he p cticable 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 asmall quantity generator,Ie ood faitheffort to minimize mywaste generation and select the bestwaste management method thatis availableto me that Ican afford. ual signing inthe 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 wasteand materials are true and accurate ed,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer shall abide and be b and bythe Standard Terms and Conditions on the reverses5ecuace.OrdPy Custom Igtiature Date Drive raI ure : I : ate Print Name Pry©rive Nam - i'