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SERVICE ORDER t <br /> FSR SEFiViCE CALL: . <br /> "ASBURY ENVIRONMENTAL.SERVICES, DBA j FORM NO.WbES004-D (1/17) <br /> PAFILlEFt ' • � • <br /> SERVICE ORDER NO.' <br /> FORACCOUNTING CALL:; W01w 0, N2WM7 <br /> 562-231-1550 <br /> 0 <br /> AF 125 <br /> VIIIORLD,OIL <br /> ENVIRONMENTAL SERVICES- <br /> H STOGKTON DOppeiNC 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> 11-559-498-0240 - <br /> .p 3333 AUTO t"ENTERQIRCL E PO g0?(.8009 <br /> p WWW.WORLDOILCORP.COM' <br /> DSTOCKTON,CA 95212 ,CA 95208 <br /> T TRANSPORTER EPA#CAD028277036 <br /> (209)477-3688 (209)STOCKTON4777.3868 <br /> CUSTOMER T1 •PURCHASE,ORDER#1 ROUTE# 'TRUCK# CONTACT NAME ORDERTAKEN'BY HALIDES <br /> ST0627' ROUTE 124 SCHEDULEN <br /> DATE REQUIRED DATE ENTERED, NEXT SERVICE DATE CUSMMER EPA# BILL of LADING/MANIFE5T N <br /> r e s <br /> WWI ; CA.M81 976W <br /> PART Imo` DESCRIPTION . QTY UNIT PRICE 'CITY K TOTAL <br /> WOSC. USEoil.SERvicE.CHARGE - $00.00 �-. $60,00 <br /> WO ., USE MI}�ED,QILS'' 235 30,00 31 N'. i0:00 <br /> Sbveetw, Get signature from Cosy. <br /> TOTAL,. <br /> CASHALCD- CHECK B . NanagrQr:Saw!C,iaitaly <br /> WASTE DISPOSAL INFORMATION „ - <br /> .NbN,RCRA HAZARDOUS WAST:LIQU(D.psm biUMIXED OILS) STATE CODE 221. <br /> NON•RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)' STATE CODF' <br /> DESIGNATEDT5DF: �U#�EN1fIR�l�FI�S�}Yi�IbE�G�RE1�1924M,7�,T.;�`!xC#L� X611-4B�G��Al 9A0 <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUM5: FACILITY: BSC <br /> GENERAJOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> -•By signing below I hereby cotd,f),thap <br /> (Waste oil generator/customer MUSTcheck ONE of the following three boxes) <br /> 741)l have not mired any of[ha waste described Shave With arryeingl'f:azardousova{I+.•.lhr tPIJ1 hatulo contort is LESS than.l,"p)sm,and the wane does not ccntaln any PCBs:)have cbmpka with the requlrenwrits of <br /> tho apl kalilt Catirdmta used all nunagGncnl rMulatlens to deicrmEne the 4 irutr.S agne tc*caapi lheaddIilonAi:haiges for Ihed l ltjeisal of ihls waste if the infannar Ion I have provided about this waste Is into r reel <br /> []421 have rjot mixrd any of she wnstgefascribed above wllhanyvthar hazardous waste,the total halide content is GREATER Ihan),OD0 ppm,and the waste does net contain any PCs.I <br /> have pterkl v!proycr docuntetrt4Urrn to.yyoM Oil EmdronmelSWl Svivices to rebut the presumption that this Waite was mixed with,al her hazardous waste.I ag{ee to attept the addi llonal charges,for the disposal of this <br /> wade if the In{crmatfon I have psov4ded ahauttYtis wJ3ir is hecOrrC[S - ' <br /> []Irv7hls waste Es from a tankwhldi callcas y0l.fe dl Irom hvt:wSAl'do-It-yourself"(DIY)and/or conditionally exempt small quantfty genwatar iCF.SQG)sources.To the best of my knowledgr the onlywviw oR conlAned <br /> in rpy olyl CE5aG coll"1113'n tank 4 ta)ey f,;rm RIY a.ndlor.CAQGtoW Ces,1 have'not mixed this'waste sail with any otherhirardokt waste or waile'ofl fromalher sources.I agree to accept the additional charges for tllspasol <br /> of this waste If the informatlon I have provided about chis whsle is incorrect - <br /> (AII generators/customers MUST rears the following text and check the associated bax.) <br /> }ll lam a Lnrgr quanifiy gnntialor,I ccruty Ihan I have a prorgrarn In Plicc to reclucr lhowtwne.nd todcily of wauS gct+etalcW to the deysee t Is>w dete+mined in a lie iiru,mic diy prat lit able and lhst I hark <br /> selmrd sha f5rattirabio met hod of ircatmcnl,s;erige, disposal curtcnily available io me which rwnirn;i*thepraitnt Snd futufe threat to huinaan Ilia and rhe rhvhonmenr Or,If i Oma small nuandty!)enuvvalpr,l� <br /> Mu'mxJo i good 141th effcrl to rrxrrSmlae my wpsre gtneratton arsrf snlvtt the be,%t w+iso rlraniggmerlt mmliod that is aIyaomble Ir!me rhiii f tett affnrd.f <br /> This Indlviduxl slqning In the spate set forth below ori behalf of Customer represents and warhmta that he/she has the authority to bind Customer,that the lotgoira)c1muptlonsof waste and matMlals are true and accurate <br /> as pjckaged,marked and labeled,are ready for u:uiiportatlon In iccordance with applicable state end federal regulations,and that Customer shall ablde and he bound by the Standard Terms and Condlllons on the rrsrra• <br /> sldeofthisSui vice Order. <br /> dv <br /> e_u;turner Signature Date Driver Signature Dafti <br /> far-int hlamP rtn Drivers Name <br />