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SERVICE ORDER <br /> FOR SERVICE CALL: I <br /> .o PARLIER t �ASBURY ENVIRONMENTAL SERVICES, DBA FORM,'NO.WO.ES004 <br /> 5i9-498-0240 ;ti SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: { <br /> 562-231-1550 r.' N2645932 . <br /> F Sk J; <br /> WORLU OIL <br /> EN'VIRONMENTA- ,SERVICESt.r <br /> H STOCKTOhI 1a0Q0E INC 14287 EAST MANNING AVE,PARLIER CA 93648' <br /> I 3333 AUTO CENTER CIRCLE 1-559-498-0240 PO Box$00$ <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> STOCKTON;CA 95212 TRANSPORTER EPA#CAD028277036 STOCKTON,CA 85208 <br /> o (209):477-3668 (209)477-31888 <br /> CUSTOMER#' PURCHASE ORDER III'-, ROUTE#. TRUCK# CONTACT NAME ORDERTAKEN BY HA1IDES" <br /> ST0621 :E1R-86 () �� ACH ROBERTS <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# HILL Of LADING/MANIFEST I <br /> �3h 3(2A18 CAD98196788d, <br /> PART'#' DESCRIPTION. QTY UNIT PRICE QTY P/U TOTAL. <br /> OILY SO OILY SOLIDS PER DRUM 1 $125.00 �. . •• 125.Q0 <br /> 566-OlTM ';:S$.GAL'LOIV Orf©RUM(RECONDITIONED) 1 $52.00''... $52:E10 <br /> BA1'GH <br /> ffeadv iT 1101 It Sar►illoi xdere►afth aseaf c(haxwatke.f�ardiask�{alta f3padifWNf,;ufs ed)are o b to an SpA•Fee: . <br /> CASH REC'I7: CHECK-4— .. . . . . . <br /> WASTE DISPOSAL INFORMATION i <br /> NON-RCRA HAZARDOUS'WASTE;UQUID'(USED OIUMIXED OILS) STATE CODE 221: <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLY�qL SOLU110N5), STATE CODE <br /> OTHER- <br /> DESIGNATED TSDF: <br /> ALTERNATETSDF: _ +� <br /> I DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> Ry signing below I hereby cdrtiry that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> p o 1)I have notmlxed anjohhewaito described above With any ulhca hazardous waste-the total halide cahtm Is LESS than o00 ppm.arscl the wdslt-does not tantam any Pcito here complied wuh the rMrylr¢ments of <br /> the applIcibleCofifornia used oil milrnaqtment tcqulaliWns to dv%vnqne thIsIs true,I agree to aColm the ad1di0CftlC&-wges for the disposal of this waste if the infonotation I have for*4cd about this waste isincometit - <br /> f�it2I have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any Pus.I <br /> have provided proper documentation to world OifEmlroghsental services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges-for the disposal of this..• - <br /> wasto If the Inforrntllos)I Jhave provided aboot this waste Is Incorrect <br /> 1�+3yThllwxlc iS-frpmatalrkwhkhtplJnrlswaite' front houwhold dodl-yourself'(OIY)'and/orcondstionally exempt small quantity generator(CESQG)sources To the best ofmyknowledge,the only.waste efl''ontalned <br /> In my 04 V/UW tollee t lon tank i t 1-ley from Piyaridh 4msbisscuttei I h ave not mixed this was le coltwith�a ny or or hazardous waste or wan a o)from other sources:I agme to accept the additional ch�x'goS for dtspoial <br /> sof this waste It the Infermatton I have prevlded oboutAls wosu IS1nCorrcct ' <br /> (All generators/customers MUST read the Fallowing text and check the associated box.) <br /> 1$411f I aura large quantltygerwsatar,I certify tlsat I have a pragrom Irk place 10 redact the volume and mmoc ty of waste gencralcd so lite derarec I have detet rained to beecwsnmlwllyptaclleade amt that I have . <br /> elated the practlrablemetflod of lfeatment.slara¢e,ardligoW turrenrly avallabfa to ale which mlrllmi?&1 the prcienl artd future IhKdt to hhxnon Me and the envImgr;tm;Or,If I ata a small quarifIty generator,I <br /> Y,"L' <br /> mu do a good Wth offorr to mWmlrr my waste pcni raticnand sduct the btst+rasle mank.gement method th.st is avarfable to me that I tan alford <br /> This individualsignIng In the space set forth below an behalf of Customer represents and warrants that he/she his the authority to bind Customer,that the forgr,ing descriptions of waste and materials are inre and accurate - <br /> as packaged-marker)and labeled,at dyfor transportation In accordance with applicable slate and federal regulations,and that Customer shall atxidprrid he bound by the standard Terms and Condillont on the reverse <br /> iPrim <br /> evolve Oder. !!) <br /> rSig attt a DriverSlr natt ate <br /> me Print Drivers Name <br />