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FOR SERVICE CALL: SERVICE ORDER
<br /> PARLIER ASBUR.Y ENVIRONMENTAL SERVICES, DBA FORM NO.WOE5004-D (1/17)
<br /> 559-498-0240 WO g50 SERVICE ORDER NO.
<br /> FOR ACCOUNT!_NG CALL: WoDIY 0 N'2456732
<br /> 562-231-.1556
<br /> AE 17.5
<br /> ' WORLD OIL
<br /> ENVIRONMENTAL SERVICES.
<br /> H STOCKTON DODGE INC 14282 EAST MANNIN6 AVE,PARLIER CA 93648
<br /> P 3333 AUTO 0SNTEER,:0RCLE, ; 1-ss9 ags vzho 00
<br /> PO BOX 89
<br /> P W.WW.VVQRLDOlLC0FIP.COM .
<br /> Y STQCKT'ON,CA 95212TRANSPORTER EPA#CAD02827.703-6 STOCKTON', CA 95208
<br /> 0 (209)'477-W.68 • (209)477-3888
<br /> CUSTOMER# PURCHASE ORDER.#, ROUTrz# '. TRUCK#.'.. CONTACT NAME ORDER-TAKEN BY HALIDES
<br /> STO&V ... .ROUTS 124: ,p SCH80U_.LED4
<br /> DATE REQUIRED DATE ENTERED NEXTSERVICE DATE CUSTOMER EPA R BILLof LADJNGIMANIFESQ
<br /> 1011 e/7017 101112CI41,'T CAD981067B80 ���..�7 ' �j
<br /> PART h DESCRIPTION QTY UNITPRICE QTY P/LI .TOTAI.
<br /> WOSC. OSED OIC..SERVICE GHARrE,, 1 $80.00
<br /> WO Q1 gp 01L Y KlXrP AILS y., r •450 $0.00 $0,00
<br /> MATCH 11 _
<br /> Cro m Streets;.
<br /> TOTAL
<br /> CASH RECD: CHECK:# RaCa+A1t F�fsl~s�er,M&MC3ataiy_ µ
<br /> WASTE.015140SAL INFORMATION
<br /> NON-RCRA FIA2ARDOt1S WASTE,.LIt?Uti](U5ED O1LIMIJ(ELi OILS} STATE CODE221
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS),:. STATI CODE • �
<br /> OTHEii:
<br /> r
<br /> OE5IGNATEI7TSDZ; arA6.
<br /> URy_ZW C NMPir�. 11IC15 C;ERE%10M.11111GRr AMN-RD 66639N='
<br /> ALTERNATETSDF:
<br /> DRUMS P/U:' . EMPTY DRUMS: _ FACILITY; ESC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX)
<br /> Rr+lyrtlry�rtIN ci,ycnrrrytrtat (Waste oi,l generator/customer MUST Check ONE of the Following three boxes)-
<br /> +tI t havrnw mixed any of the watir'dcxr ibcd agove wit harry.atbef hw}ardow wasic,the total halWo coolant is LESS than I,gpoppm,arW tho wastvdgcanot[ontagj any PCas,l ham cornpfiedrfllh the mclulraimnp of
<br /> the 7ppiicaW Uklarnin used tsll managmaril rer)ufalkins to dcicr:nlrse this esarue I,agree la accept chitadch"nal ra,.vges roe lhts di poso of this wont if""inlo[mmlon I have plgveded ahgui thlswaiie'is.irscmt u. ^
<br /> M 0 1 hast not mi)Nat ry of ML.watbe described*ovrwlrh anyatiser haiardous waste,this total haledr xgrsjent Is GREATER than.i,010 ppn%.arnf thew4te does not cgntajn any PM,I
<br /> Itacc pftr+ldtd proper docinnenhdion(o•World Oil Enyteci"wtal5ervl[us totcbul.thorpresompllan that dot+wassc.ryVmikrd wlth,dthet humdpvrswasic.I a ve to acce-Ft joke at)tnithenal cf)argas for the dl;Rosa1 of jhh
<br /> waste if tits idfwrnategn I have Prot!kjcd abpur INt wasie h ln[arrcct,.
<br /> 91f31 T MIN-mlo Is fp6rn a tang whlclscullccm wasic oil frim haJief;atrl'iicdt•yawiatf^{E11Y1 LwWor Son dlelorraley exempt salol/epianrity ginnWatar(C MM-3 source{.To the best of myjtnmyl*. tk.the enlywaslaoil'[antdrit4
<br /> myi,?ICEst)6txilk:iioii tank is soky frgin❑IY andlar CESCG ic40-F l hasti nbt mikeit this waste oil wleti Ienyotivr hatwiketh wastearwastt Oki from ulher%OIRCEl,f,prrr to SccePI the additigrwsris]u"Tai ffhposal•
<br /> oS 11,h•was f j nform..it i h.•rvrprwufcdabout Ihlreawsteis}newrrsti t
<br /> (All generators/-Customers MUST read th.e?following text and check the.associated box,)
<br /> I amafarrtc quantity ncrrc•ratur,l cetrify that 3 have a program In place W redu[r the vrtkimr and loxf[ltyolwastc generated rd the drr)rec!hon drterm;t>rd ra I+e cConornkally practicaWr and that I have
<br /> tin I the pra[tK able v --Sod of urAl henj,iloragc,or dl+Pdsal'[ulrvritly acral rahk to nie vlhit h minlh,lc's[ho oLnent a1W lul i,re iNeat Iv human}lfe and�t}te� rnrimcnL Or,+f I am a imatl�uanslsy gcocrdlor,I
<br /> have motto J gond faith el lwI to n:lnimlic my w.mte genera t Ion and telq[r civ bort wauC rnam9emtlni mvhoi'tr,'at h a v.14ablp ionln %h31 I[an afGj[d,
<br /> This 1ndls hlual slgnino In the space.:et forth below on tehalf of Cusp orracr icpiismis and warrana that he/she Inas the authority to bind Quxtrwr, I ft fur ig dee waste and materials are true and accwate
<br /> as packayad,mashed and labeled are ready for namparWllon In accordance with applicable stalea nd federal regu6tions,and Thal Customer eh ahMe a try the .ndardyt-ares and Conditlons on the reverse
<br /> side of Ihls Service Order
<br /> s
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<br /> Gusto &signature Date Driv rSignature Date
<br /> 2.r e- �)dc I e- ` e 4&�
<br /> r Print Name Print Drivers Name
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