|
FOR SERVICE CALL: SERVICE ORDER ,
<br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM No.WOES004-D (1/17)
<br /> 559:498-0240 WO 6510 SERVICE ORDER NO.
<br /> FOR ACCOUNTING CALL:
<br /> 562-231-1550 .• Wooly a. M2415698
<br /> AE 125
<br /> WORLD OIL
<br /> ENVIRONMENTAL SERVICES- "
<br /> H STOCKTON DODGE INC 14287 EAST MANNING AVE,PARLIER CA 93648
<br /> 1-559-498-02'40
<br /> P .3333 RUTO CENTER CIRCLE . PO BOX 8009
<br /> E, WWN/.INORLDOILCORP.GOM
<br /> T SfOCKTON,CA 952.12 TRANSPORTER EPA#CAD028277036 STO.CKTON,GA�520$
<br /> 0 (2091477-3888 (209)477-3668:
<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES,
<br /> ST0627 124 �/dZ f. SCHEDULEQ-I
<br /> DATE REQUIRED DATE ENTERED NEXT 5ERVICE DATE CUSTOMER EPA# BILL of LADING/M..AMFEST#
<br /> 81712017 8/7/2017 CAD981967880
<br /> 0)..4s 7 k1 jal�(,
<br /> PART# DESCRIPTION QTY UNIT PRICE. :QTY P/U• :a, TOTAL
<br /> WD USED 01l 1 MIXED Oil ;'15Q,'3.. $0.,00. .. •.. ;l 30 W
<br /> WCaSC USBD QIL!§ERVICE CHARGE $80,00'
<br /> BAT04
<br /> , vl;d.u•dinl
<br /> r iPJ,sbi-e ,...- '. .. ''�• , ., '.:. -•• .- •. �' '' i=r.••:.n,
<br /> ki :,j...
<br /> l: , TOTAL u:: ir,a.r,
<br /> CASH RECT): CHECK to If' I y:7P,rr r A•rt:a:!
<br /> WASTE QISPOSAL•INFQRMATION
<br /> NON-RCRA HAZARDOUS WASTE,•LIQUID(USED OIUMIXEDOILS) STATE CODE 221
<br /> -NON-RCRA HAZARDOUS WASTE;LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> OTHER
<br /> D SiGAIATEDTSDF B RY ENVIR 71NfdENIAT SERO E3`C -Y EUOQ�i 6
<br /> ALTERNATETSDF:,
<br /> DRUMS P/U: EMPTY DRUMS: FACILf7Y: DSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) „lt
<br /> By signing below I hereby certify that:
<br /> i
<br /> (Waste ail generator/customer MUST check ONE of the fallowing three'boxes)
<br /> a 1)'[have nmt mlaedany of thewasto doscrtimd afwvewhh airy oifl hazardous waste,the fetal h:,Iid6 cowrru Is LM than 1,M ppm,and the vraste does any PC
<br /> riot corkwin arBs.I him fl!led with rho requiresrients of
<br /> the applicable G+IiW61a used ell risanafjllnent leg Aide?fodnterri+ to this li true.I agme to accept the oddltlonnl thMges for She di+Posat of Ihls was[eIf 1lie Infwmallon I lova provkled abort liars Waste is Incone[L
<br /> L�a21 have not mixed any of the waste described above with any other hazardouswasie,the total halide content Is GREATER than 1,000 lapin,and the waste does not contain anyYCBs.I
<br /> have provided proper documentation toWodd Oil Environmental Services to rebut the presumption that this wuu.was mixed with other hazardous waste l agree to accept thu additional charges for ilm disposal of this ,I
<br /> wastr If the Inforrrradan)have provided nbolN Ibis waste[s Inenrrat �+-- i � '
<br /> Imon)-thto 151{rico a tank which col$Kuwasce all frons househoWd'otlt•yaunrll'PYd and/or caaditwt wlly exempt.srn+R quantity genrralor.ICE*j wuices To the besi df my kntro,ledge,the rinly viaste59l.con il*
<br /> In my f][YICr:50G[rNlrctlorl Lank is snlry sewn f7f'randlar CES(?G snorers(have raj!snkerl this wmin,0 with arty other 4uardo+ts waste or wasi!•did from usher source}.I a gree io accept thu addi tlonal chirup fps.dlspmal
<br /> 'of this waste if the Information I have provided about this waste Is Incorrect
<br /> (All generators/customers MUST read the following text and check the associated box.)
<br /> ray If I am a Barye quantity go neral w,I ee+lifytlsal I have a Pr09ram In Place Io10tiee Tho volume and toxicity of wasle generated to she 6"We Ihave dcteimined So bo economlcally rnortlwhie and that I have, i
<br /> s the prdeticAtAil mo hod ur treatrnmt,Longe,or ddip6satcui+ently available to rise which mlntriaw%the plrbwnt:rnd future thrtxt Iq h64h&n Ide artd the erMtontrwk or,If I am a srrktlt quantity generator,I
<br /> havemade a rgood.dalth offorcick mlrija xe,my wasteSpnftjlW and szlm tho best waste usa sagotrvnt rneihoci that isavirbfilr to nrr that I can And,.
<br /> This individual signing in the space set forth below on behalf of[Widmer represents and warrants that he/she has the authority to bind Customer,that t ru, deecll pontos waste and materials are true and accurate
<br /> as parAaged•marked and labeled,are ready ror[ransportatlon In accordance with applicable slate.and federal regulailam.and that Customer shall a ' and and by a Standard Terms and Conditions on the reverse
<br /> side of this Service Order. '
<br /> Custo r Signature Date nature c Date
<br /> Print Name Print Drivers Name
<br />
|