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FOR SERVICE CALL: SERVICE ORDER PfkRLIER ASBURY ENVIRONMENTAL SERVICES,,DBA FORM N0,WOE5004-D (1/17) 'S59-498-0240 WO1� SERVICEORDERN0. FOR ACCOUNTING CALL: WODIY 0 562-2101-15510 -- 0 N242=5 AF 125 WORLD OIL, ENVIRONMENTAL-SERVICES,. 14287 EAST MANNING AVE,PARLIER CA 93648, H STC�CKTON DODGE INC I �, 1-559-498-0240 P 3333 AUTO CENTER CIRCLE WWWWORLDOILCORP.COM PO Sax 8009 E ° STOCKTON.CA 95212 TRANSPORTER EPA#'CAD028277036 $TQCKTC)N,CA 95206', °.. {209) 477-3868 M 477.3m. CUSTOMER# PURCHASE ORDER# ROUTE# T/RRUCK# CONTACT NAME ORDERTAKEN 8Y, HALIDES ST06V . . 124 ISCHECUUL ED-i. DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA#, BILL of LAD;NGIMANIFEST# W=017. . 812812017. CAD6819876$a• D I ?71 E �' `„ PART Y' DESCRIPTION QTY: UNIT PRICE.,- QTY-PIU: ,:. TOTAL wosc USED OIL SERVICE PHAR04 I Sam $80.00` WO dStb 611.1 RXED OILS, 00; $0.00 •r• 061 a 5#� I ci rAL i CASH-RECD- . CHECK fd_v AoaatirttMgmger;Swit[3atery WASTE DISPOSAL INFQRMATJON F W NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMMED OILS) -STATE CODE 227 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: i7ESIGfdATEDTSDF: A58t}Rif`1w3tNlRfi)fd1�1fJ�FPA>L�i �dI�E�C£�1E3�82�11>tBRQP�ft t�;C!R@��(i�j5dt=tB2�;C11tfP005!'t�:�t7 ALTERNATETSDF: DRUMS PIU: ENIPT1r DRUMS:— FACILITY: _ RSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By sinning below l6erebycertify the4 (Waste.oil generator/customer MUST check ONE'of the.foll6wing three,b&iI 1)I have not rnlred.any of the waste dcscnbcrl above wdh any othur hazardous waxo,the spial halldecartent Is 1.E5S char Ixa pprn and the requlremeamof appfltable CA11kn la used oil rrrarwuaamem seguLstlons toefootmrna ihk h title.I agre0 toaccapt stir additional charges far this dkposal of thltwasteif the lnrwtr atfon I have proMod about this waste Is Waited .•r MMI I have not irlrM any of shit waste deserlhed apnea with any a hu.hocardasn waste,tho iI III content is GIIF+5fIR than 1,01MY ppm,anti the waste does not contain any P.M.I ham provided piridowrnentntion III Cbl EnWrss{ltrranlal gcrvlces to rebut the ptaiumpsIon that this waste w"mixed with ether hamtdouswaste,.t tsgree10xcrpt thea"flonal chargEs for ilia disposal of this;;( waste ifow Information I hove provided about sts,wade Ivintorrtc! CSA]}Tttls,wasteFsfrottiawrdtwhichmil t}svaiteallIram,househrsldVa;it-yotrnelf'w1YlantUorrnnJltionallyexemptsmall.quaptity9epe[aror.ICES[7G],sutu.ces.Tothebestofr krwwlpdge,lifeonlywa:teoi{cprttalnad In my o1y1 CSSgG collection fank Is whry,ilom DIY andPor CIaittulcm l lmvc not mired this waste oil with any other haardisus waste ory Ic oil from or her sources_I agree toatI the additional chartkirsifN 0II of thls waste If tho Information I have provided about this waste Is Incorrect (All generators/Customers MAST react the following text and check the associated 66x,) IeQ If I am a large quartiltygenerator.I terflhy that I have a pis mm in htaee to reduce Ilse wrlurnr and totkity of wast!generated}o Ile degree,I Izaygdetnrrnrnrd to Lso gtoryomlrally practicable aqJ IhLi[Illavo. sere ied the piadtCable method orreer,f IIrIttirage,or-dispocal cutrimilyavailable to rev wI naniFnim%the pritent and future tlpest tp htirnanMe aljdt6t3trivlionnI Of,If lama mvil.quanoty gapmkot,l;. I made a goad fali{ef.6Ito Tliornb r Irvwasta rrynoratlon And III the tm!Iw.tste nutwgemerit mel hod that 1%avarinbie tv.mI I can JHp!d. 71tIs hrdlvlduataiprsfrsg iq the apace un forth beI on behalf ref Custornrr represent;and warrants.lhat h>crshc hat the authothytobind Cummer,that gskterlpston%of wastea nd materials ai''e tree and accvraIa ns pKkojed.rm;%ed And Iabrkd,are mi*for transportation In occotdaarce with applicable an state and feifwar regulaticu d rhat Curusrnm sl* .e and and by the Standard Terms and Crrrdhipio cIn Shrsryv iia sideAftl'Ji54 ir. �f 6 �/ » C Omer gnature f Date river Signature Date Print Name Print Dri e>'s 'ame.