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z <br /> FOR SERVICE CALL: SERVICE-ORDER <br /> PARLI—th ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO:inW0ES004-D (1/17) <br /> 559-49870240 " SERVICE ORDER NO.. <br /> V1fC 8Sq <br /> N. <br /> FOR ACCOUNTING CALL.. <br /> QQIy <br /> 562<231.=1550 N2489�12.. <br /> f AF 125.. <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> H STQCICT ON DC}DGE INC 1.17.8'7 EAST-MANNING AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> P 3333 AUTO CENTER CIRCLE PO ROX B00& <br /> P; NlWW.WORLDDIL'COFi'P-COM . <br /> E' <br /> STOCKTORCA 95212• TRANSPORTER EPA 4 CADo2k77.036 STQCKTON,CA 95208 <br /> e (700 477-3688 (209!1477-36$8 <br /> CUSTOMER# PURCHASE ORDER# ROUTE'# TRUCK#- CONTACT NAME ORDER TAKEN BY HALIDES. <br /> STO827 5 7UTE IN SCH�EDULEI -I: <br /> DATE REQUIRED DATE ENTERED NEXT'SERV[CE DATE CUSTOMER EPA A BILL of LADING/MANIFEST 9 <br /> 111,810,17, t 1l01I{l 1 T-..... L`AD $199788Q 77 <br /> PART.# DESCRIPTION "' " `' QTY UNIT:PRICE- ;QTY P/U TOTAL <br /> USED DIh/MIXE©'QILS': Lla00 <br /> ,'W lwl Us OLS-ERVICECHARGE::;':;,, <br /> i <br /> OATCH0: <br /> -TOTAL y <br /> CASH RECO:— . <br /> r COEGK ► G +�.�ll er Ste�re'C�etety. t `. <br /> 1 <br /> .t.,,, 1':. WASTE Di 005AL:INF613MATION a <br /> NON RCRA HAZARDOUS WASTE.LIQUID{USED OIVMIXED CLI 5} STATE C00E 221.'1 <br /> NpN;RCRP,WAIZARDOUSWASTE,LIQUID(ETH GLYCOLSOLt)T If)N5} STATE CODE <br /> rbTl-l�R• _i' <br /> A- DE516NATft)TSDF: ArSB1iR1'$q+[�II 1+iM 38RVl��� RE #its$-1110MW4_fil <br /> ALTERNATETSOF: <br /> DRUMS P/U: EMPTY.DRUMS:- . X FACILITY; BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHE(KTHE APPROPRIATE BOX) <br /> Ely srryn laq b0ow I Itemby certify that. < <br /> (lNaste oil generator/customer MUST check ONE of the Fallowing three,boxes) <br /> y�`\1 <br /> IIs- not qux•d artyof Itiicwastr•dw,etilsed ab&i*�Ilh ori ulhcrhasankui waste,Ilsetotal h,wg corilonr isLM Thin 1,M 9111y amI till w.rsrr docsnercomltin any PC6�IWWcompll dwllh the, qAli ppnI of <br /> pp11W.Cahlomla tnwd all tnao?.gt i?anI wgulalloiM 1a do lstlmina Ihill is ftue.tagica la accepM% ertt Iaddidel charges for rhe dtpt"&Wof Mwa tte If the lnror rsiative on I haprmidod about thiswaste Is Inrrecocii i. <br /> D+21 have not mlKtd any 9f the wing d*sctibct abova with ars)other hawed=waste,the tonal hilida Con tept.ls 43AWN then 1,000 ppm,and the waue does,not tomlalri any PCOs.f ' <br /> h arc pfgvjflod prpprt du[umem,l+lm to Mint Id pH Enulfon muni of Servkm To:tehrsl-the luoymp tion that this vvastc,was Mixed v/ith Other hararduui was tc.I agree to accept the dodllionihChprgo for the disposal of this <br /> waste i!tho."ruims+irm}hour pnnrhhtnl.bates thk wa%lu is Irrietrai,, <br /> =1r3]l7uswadi is from a lank which tollw%wasiN 011 frnnit houLehold"do-lt-y&d.F ell'Myl acid/or cohditlonally exempt small qua=y genctitof(CESQG)touice0o the best of my knowledge,the only wast5 oil contalfipd <br /> in rny�ilriC55pGkui4cti64t1 bnkiti ielq Plum t}IY tn&OKE�gCss6Ur N&I have nolmrxrd this wale oil with any other Kumdous waste or w,iue oil from other sources-I agree,tq ircepi t4 additional charges for Ditpnsal <br /> of this waste 11 Oto Watmat lon I line provided about this wait*It incorrect ' <br /> (ATI generators/customers MUST read the following text and check the associated box.) <br /> +•t]1f I am a large quantity Wcfalw.I cel Lily Ihat I have a Wo'P am lrl Ptxr to reducem <br /> the volume-Ind WINY o <br /> nd NOf wa sl a genera led 10 the degtm I lh.ive doted n1 nod to be econtmtkallr practicable and that I hve <br /> a <br /> ecte4 the Pt actica ble method of tr6i mens,sr rrr,190..ar diarios.sl can endy avallabk to erre wlskh minirniras Ih*lfresenl arsd Future lhtaa13*hi m n U142 and the a nvrsonrnrnt 01,d l om a until quantl,y gen orator.I <br /> . 11 •e made a good falth effort to minlrmlc*my wauti 6ancrllW11and sptecl it%&bf•stwasten,amigement method that l5 available tom*that I can alford. <br /> Thi iv' Ong in the space set forth htlow on behalf of Customer represents and warrants that he/she has the authorl ty to bind Customer,that the forgoing descriptlons of waste and materials are true and accurate <br /> s Pa •d mw d and labeled,are ready for transpanatlon in accordance with applicable slate and federal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br /> attic- f ,I selvlcs rdbr. <br /> C st r• Si nal ire Date Drive grlatu Date <br /> flSAJ IR, o �Q,h ;> <br /> Print Drivers Name <br /> PFint Parne <br />