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<br /> PARD SERVICE ORDER
<br /> " ASIBURY ENVIRONMENTAL.SERVICES, DBA, FORM NO.WOES004-D (1/17)
<br /> X59 9t3�0r7 0 VW0.650SERVICE ORDER NO.
<br /> FOR.ACCOUNT4 CALL: WOQIY D r N2a7CKi56 `
<br /> 562-237-1550
<br /> AF 1251 n'
<br /> �RiLa OIL r
<br /> ENVIRONMENTAL SERVICES,.
<br /> S .kTOCKTON DOIDOF INC, . 14287 EAST MANNING AVE,PARLIER CA 93648
<br /> H � 1-559-498-b240. • '
<br /> P ; 3333 AUT CENT-[ti-CIRCLE \ F'0 84X 8009 ...
<br /> E WWW.WORLDOILCORP.COM
<br /> °- STQCKTON, CA 95217 TRANSPORTER EPA#CAD02,8277Q36 STOCKTON,CA 9520$',
<br /> T (209) 477-361 B (2 477-3698.
<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES
<br /> ST0627C �ER•88 BILL QN SITS sgtrintarral
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST d
<br /> 11/7/2017 CAD9819VO80 y
<br /> DESCRIPTION . QTY ' UNIT PRICE,. 'QTY F'/ TOTAL
<br /> 4.
<br /> a
<br /> stave trey BATCH — —
<br /> CA CI R G'D; >CMECI # Aoccot Manaser..Sava Gata,y
<br /> i t';• 1;.- , ,:,;.«,- :a :>.. ASTE DISPOSAL INFORMATIOhI
<br /> NON''-RCRA HAZARDOUS WASTE,LIQUID(USED OiL/Mt7(ED L71L5) + tiTrCFF CODE 221 ".
<br /> z NON=RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STi1T''.`ODE• ,.-_-:•
<br /> �4�FA,SAO
<br /> H[} U31NA5i'E��,(E1.(F1L;7` R
<br /> fllRlfV!!Y 411 IATF.
<br /> OTHEM NQ&aCR4 E� ..:----_--- ---
<br /> 'DESIGNATED.T5DFi` r ,
<br /> -=--YEIjIFR��f1FE-�•9'f}-F•8'E;'f`.LiM�` .`'95386•,�8��29ti3-------..--.___..._____.��_:_-�_ ._..��__. �
<br /> ALTERfATI T5C1f
<br /> DRUMS PlU•_ EMPTY DRUMS' FACILITY: B3 C
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX)
<br /> By-.I]iilng below I.heteby certifyihaI:
<br /> " (Vyfaste oil generator/customer MUST check ONE"the following three boxes):
<br /> f el}!h3Ja na[mixed any olthe wauc desr r 1 rd abavp ivfih any other hnrardous waste;Utv lotal"'do cement If LM than 1,61M ppm.and the complied with the requirements of
<br /> thoapplicable Olt";used oA management ryplalions in detemilne this 4111101 agree W accept the additional charge for the disposal of this waste if c ie,nforrruUon I haft preulde d about this waste is incorrect
<br /> i=iV 1 have no maxed any of the waste described above with any Ohm harnrdouswaste,the toWl hoNdd consent is MIIMICA than IAQO ppm,and the*ante does not contain any PCBs I
<br /> havaq[ovklsgpror}rrrloeyt,ppllvn:q,y/rnld0!,ErawhonnxmsnlServklntotetwL?firrssesrmpslonti1s[Ihisw.sstcWa1mires)w1Urotherhaxanlpslswaste.Iagrretoaccepttheadditionalchargesforthedyposalo(thIs
<br /> waste}(tha�pft7rmmfagJ.have yxprkSrU.aboul.tlds wa}La b.irs5{u:eci, :.:i ., .. ,• .. ..
<br /> I=)1]IThis.wail6Iifr , iahkw*I hl'ealtaes�waslecllfrcrts'Flouieliolilf'rinitlomitseii'(01VIani/6r[ap6ulor0l,exefnplsmaltgiro lnygt+nciat;ACES{jGjwdrees:Tofhebestdfmykriowiedge,timvoywastifalcontained
<br /> In irry,!`f71Y![r•`_ � fkldnl3nk s`sol¢y hornf7PragdldFt:E;t7t ssk',rces.I hale 1101 rrshryd 1615 waste od with:ny other fsayansntss waste of wattc oil ham oihei sourcei.I agree to ixtept the.addl(WRI chargt•s ror d1spo6l
<br /> Wihli wamvif thv hsTormai ien 1 have provkhd about this'wSsto Is Incorrect
<br /> (All generators/customers MUST read the following text and check the associated box.)'
<br /> rrAl i I am�ttrgr ar tiiy.grrtrr,tsar,I cortliy 1ha1 I(save a program in place 10 reduce the volume and Ioxltity of waste gerurated to rhe degree I have datetmirretl 1fl lsc rctmrxnlcally pracllc�blr xnd t6a[I have
<br /> soMi a prat[Iraulde'rslut6ed cf truatriicnl,ita:ago,a dlspuxal'[urrrnlfy avalla6fC In me snhkh ndrtlniirds rhe present and f inure thmot to hurmin)lie and the etmronmrTts,'Or if l am a sitwp quorllhy grrserutp{1
<br /> M'arld kryodd filth alT�irY]o rrFln linfre my wassr rye6cnl11ors atsd Oki the FsrsSwastr mairagerrsrnt mel?dad fhas.is iviilabM to ms thal'Iranalfprd' .• - -
<br /> This;ndlvldual signing in the space set forth bdcrm on behalf of Custunterrepresents m,d warrants that hdshe has the authority ro bind Customer,that the forgoing desci ptions of waste and materials are true'and accurate
<br /> a5 packaged,marked and Wlx! ,ore y for Iranspol tatlon In accordance whh a'ppllc able state and federal regulatlons•and that Customar shall abide and be bound by the Standard Terms and Conditionso n the reverse
<br /> 5 of IIts Svvlce❑ f. -
<br /> r'YustorT er.Sir3r amore . gat Driver S�:re
<br /> Print ante I) ❑,r Print Drivers Nome'
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