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FOR SE.91'I:CE CALL: SERVICE ORDER
<br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM,NO.WOESOo4p (1/1'7)
<br /> 559;498-0240. WO 6.50 SERVICE ORDER NO.
<br /> t Wi"bR ACCOUNTING CA•LL: WO©IY O'. rr.,•..:..., I•,
<br /> 562=231-1550, , ., ,1., t42590832
<br /> AF 125
<br /> WORLD OIL „
<br /> ENVIRONMENTAL SERVICES-
<br /> s $TOCKTON DODGE.INC 14287EAST MANNING AVE,PARLIER:CA 93648•
<br /> I 1.559-n9a-0240.
<br /> e 3333 AUTO•CENTER CIRCLE n.1.. PO BOX 8009• h
<br /> P. WWUV W0f;LD6ILCORRCOM` „
<br /> >' S'T00KTON, CA 95212 SfCCFtTON;CA 95 8 .
<br /> T "ff ANSPORTER EPA 11 CADd28277D36
<br /> o (209)X177 68 d {2(79] +4774M
<br /> CUSTOMER N PURCHASE'ORDER# ROUTE# TRUCK# CONTACT NAME :ORDER TAKEN BY , HALIDES
<br /> STCB27 :ER-88 t"��{ CASEY avelwA..a ., �'it . ..
<br /> J.
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMEA EPA 4 " BEi Lof LADIiVGIMANIFES7 '
<br /> 814/2015 CAtlA81 S87B6
<br /> PART ff DESCRIPTION C)TY' N.Fi PRICE QTY;PIU: TOTAL .
<br /> 5' STM 55'GRLLON Cff META4 pZUM 1 $54.04 + $ Br88
<br /> MIXED' MIXED FU9� S-PER DRUM' 1 $225.OE3 l $225.00
<br /> .. ,'' ,1 't,'4 ,ISI;%. i. , ' .' ... .. .L . � .. • .. - ..
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<br /> CASFIAE�'Dr - CHECK 9. Rrlage he.,a. •to r. .r,:�'
<br /> WASTE 015POSAL i4611MATION,
<br /> NON-ACRA HAZARDOUS WASTE,LIQUID(USED Ot3:.1MIX.Ea OILS) 5TAt 'CODS Z21
<br /> NON-RCRA HAZARDOUS WANE,LIQUJD(ETHYLENE GLYCOL S.OLYTIONS) STATE CODE
<br /> OTHER:' -
<br /> DESIGNAT�D TSDF: ;
<br /> ALTERNATETSDF; )
<br /> DRUMS P/U:� EMPTY DRUMS- FACILITY: ------- .
<br /> GENERATOR WASTE CERTIFICATION (PLEASE:CHECKTHE APPROPRIATE BOX)
<br /> $y�kjnit?ghalawl!><[ebyrurtftythnt� _
<br /> M� aste oil generator/customer"MUST check ONE of the Fallowing three Boxes)
<br /> :,: '
<br /> �Jt 1I I ha4r riot in,rrd any o!Ili wass8 deseriheel al7t ms v[h a ip uthcr isaivstcu wa CO,she tot i}halide Co tial lis LW than l h ppm,and she wassc,ior.nos iontaki lily PCBs lhd etvmpl�rd Milli thNirqulreerrrrnls of
<br /> the npiall"We Callfontla used ell marragoment rerrlu lallom m de[Mmil no this is true.I.-rgree ro:lrcept the addNlonal theW kpr.the disposal of this Wbsle If Sha Infwmatl an I hove prodOW abou[this W sle h Intot6h
<br /> 0171 hrrr not mired Dnycd the riaitC doctibad a4scve w,th any nft!r h=cddu;wane,t1+r Ictal halWn tOnlrrtt I$GitMli Ilton 1.01M pprn,and she wasu!does ral contain any PC8s.1 f
<br /> I+avr p:vr.IdtW kmper dneumenlaUan,tgWmkl IEmrhnrsrny'n�s!Scr�tiees ioeehus,thGyftnumptlgnuutt lh vraliPr o}111,�i[ci�5y�tfl,QlhGr hayaltiuus,rasSe.I��ar ea a:tspLt eacfsl��ionol Chargesforthe dlsposal ofrhis,l
<br /> wa:irl)lhemldnnefkan.lhdvrrWGvidrdaSouLlhiiwasiei fniorrect. _ �, ,I• ••� ♦' i :., �. i� .,
<br /> Da3lThiswa+l�l:IronraWlikw khcuSlcciswasaaiHtnrnhphseKnld'de'i�tyourscU'(DIY)arrL•'vietintGtionrlfq�xgmpFirba��quarithygencralar.;{CESgG)Sowteti7tithdbrilrlmjrhno,4ledge•the'onlywkSedlL[r}t!s}ncd .'
<br /> inmy'piY%CY3i74'culs�+c}io'risanki6Ly from plyatrth'I:r'CE54'C'suliliif.lhavenotmlredthissbsastidd�•littianyothhiha;arrloutWisleorwa;Seoilfromailieistiuitcxtarjrcetv:[cteiriliteaddhi6nal'ihdlg�4'krrzJhpnWl
<br /> of this waste if the information I have provided about this waste Is Incorrect
<br /> ��,[^ (Ail generators/customers MUST read the following text and check the associated•bois:]
<br /> (���/��-�]n)if I oma iq fqc ryvnndiy gencramr,I efttlly[hall have a)x)rram In Phan In trcluce the olllrrlo and totkltyof waue9%% r aIed to Ihv degrte hovv slrlcrmincd sa6e ceonamlwllyprxsliab a and tlwt I t av::
<br /> srtle[ICsI the pistlwpfa mrnhail ui treatrr+rnt,sioraryt•,urdispoxal turrentl)f nvadahle rtilrsr which tninlrniies theprtsithr and tuU,rc shrcai to human lite and the rnWronintnC or,l{fama7mall ry uanihy 9rncrer;,r,I
<br /> nvv m�idra guad lailh n)lars Iq erilniml:Q 11iyw.iNktlCv+eraslYr?arnf 5efir't
<br /> th'a h'rill4sitr snlnirlemcnl n,tlAgd tlssf fs aYSlLsbk to ma That I salt offud •r [
<br /> 7hii individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer,that the forgoing descrlpilons of waste and materials are true and accurate
<br /> as fuck,iijeA user and labeled,are ready for transportation in accordance with applicable stale and federal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse
<br /> s+dc of thh
<br /> Ctrsro Signa " re -� . Date river 541, Date
<br /> Print Name Print Drivers Name'
<br />
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