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FOR SERVICE CALL: SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D' (1/17) 559-498-0240 wo SERVICE ORDER N0. FOR ACCOUNTING CALL: WODIY 0 -. 552-231.155&' N2463033 AF 12'5 .' .,, . . , . _ WDRLQ•�ML ENVIRONMENTAL SERVIC,ES,. HSTCCKTON.130tGE LNC 14287 EAST MANNING AVE,PARLIER CA 93648 I 1-559-498-0240 p 3333 AUTO C3ENTER CIRCLE PO BOX 8009 P WW W.WOFiLDOILCORP.COM E D STOCKi KCA,9521 TRANSPORTER EPA#CAD028277036 S f OC:KTON,CA 95208 T (Z'09)1477-3668 (209)477-3668 CUSTOMER# PURCHASE ORDER# RO.UTE# I TRUCK# CONTACT NAME ORDER TAKEN BY :HALIDES 5T08Z7 R ) 7J :1241W SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST N 1.079/2017 10!5/2017 CAD981967M,, - b 7 . PART# DESCRIPTION QTY •UNIT:PRICE: QTY PIU, TOTAL AF, ETHYLENE GLYCOL'SOLUTIONS, 25 40,00• ::4f�• $0.08' ' G $t1 edit - TOTAL: CASRRECD: CHECK#._, Accu+jnt Mmnas :Stena Gateiy WASTE DISPOSAL INFORMATION : I ON-RCRA HAZARDOUS WASTE,,LIQUID(USED a�IL1�11X�0 OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE 433 OTHER DESIGNATEDTSDF: - Et �EBl0aG3B9B�lfV' ` K ---�4S9EJF}� FRFIR�H�1'�N•rAL�El�ifi�E�S�f�S; ALTERNATETSDF: '[! DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: - - (Waste oil generator./customer MUST check ONE of the following three boxes) O+i)I havq not mixed any of the waste described ahow with any other hazardllvt wasit'the tol sl halide content is LESS than 1,000 ppm,and the waste does not cuntain any PCBs.i hwaeomplied with the rrqutr ehwjits of the applicable Gilifomla used oil management regulations to determine this l%true.lzt"e to'attept the additional charges for the disposal of this waste If the lnfermatlon I have provTdCd about this.waste is incorrect C—_W I have not mixed anyrof thnwafie dew(W a}iav%r hvllh any other hazardous waste,tfra local halide content Is W!.MER than 1.0Gu.ppm,Ind Ihewxstadtrei notconsal6any PC9s I ha6e provided peopti dofumc snatlon td tyorW Oil Envinshrr ntai Swr Ices to rebuit the presumption that Lht%sv.s;Ie wa L third tell with ether ha hilus wAntf,149r c Io accept I lie uddl I l,vrat[Isaige:Iv Iht rlhpd"t of 1111% walla It Itio Inforsh ulon i bYw pi erAded abpul this waste Is INW0171' . onvator tt:E5.m spuictLlto Itte hert.orl . MCA TNAwaslo Irli mer i Sark whkh collects wast+all Irani houieriWd ifwlt•yourself i[lfy3 ar dlnr.tontlldonallyrprn+pt srnall quant}ly g. try knasah rlge,the only wade otl'cansalnod its nvwf i:fkrG collection lank 1%so!uy fiwn01Y aiitllor05"M iow eLI have not mi=ed thIiwnmeod with any otherhuudous waste at waste oft from other sewcei.I agree to ocreph the addltlon V clw*sfor dilpesal or this waste if rlsr lnforiswtltin I have provided abutiz ihli,wastrk lnconcel }�` (All generators/customers MUST read the Following text and check the associated box.) +�11f tarn a lame quantity grneramr.I certify that I hoer aprpgram In pure to redime the.voh+me is nd lovltify,of waste genet aced to the dcgrrc I Nava dotcfmlmd to Iw nconornk ally pra[iiwblr and 1hai 1 NYC. sa Isd tato praG11s;4le me shod of Ireatnhent,stoeage,ar dlipos;bl cunergly ava liable io mewhich mlydmizcK tilt present and future threat io human Itfa and the enwarhtnrm:Or,it I..iro a mutt tpwntity pnrlerattx,I hwo made ayaod faith effort to minimlte my was:ggenaratlrus and sekct the fres[waste"OnagorWnt mathod that is arairable to me that I can Afford This iridlvidual slgning•in the spate set forth below an behalf of Customer ecpeesents and wa/rants that he/she has tfie authority to bingDrivers going d crlptivm of waste and materials are true and accurate as packaged marked and labeled,are ready for Iran.portalion In accordance wkh applicable irate and federal regulations,and that Cuu d by the Standard Terms and Conditions on tyre eeverse, side of this Service Order. stomer Signature l ate' e Date Print Name me