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FOR.SERV•IycE CALL: SERVICE ORDER <br /> PA4LIER= ASBURY ENVIRONMENTAL SERVICES, DBA FORM N0.WOES004 D (1/17) <br /> 559490-0240 Mr �G r "" SERVICE ORDER NO. )' <br /> FOR ACCOUNTING CALL: <br /> 562-231?-1550 1MoUlyO � _ N253M'17 <br /> AF 125 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> S 14289 EAST MANNING AVE;PARLIER CA'93648 <br /> H STOCKTON DobGE.INC 1=559,-498-0240 <br /> E 3383 AUTO CENTER CIRCLE www.vvoRLDOILcosP.coM PO Box 80n8 <br /> STOC�i'ON,CA 95212 TRANSPORTER EPA#CAD02827.7036STOC <br /> } TON,CA 0208 <br /> (209)•477.38 8• <br /> (2091477-3M <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME 013.0ERWEN BY HALIDES <br /> ST0827 )UTE 124 SCHEDULEN, ; <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL C+f LADING/MANIFEST# <br /> 18. 3MWO ' CAD081967880 <br /> I <br /> PART# DESCRIPTION QTY UNIT PRICE QTY-P,/U, TOTAL <br /> WO U5-FP PILI MIXED OU .390.. ?x0.00, $0.00 <br /> WOSC USED'OIL SERVICE CHARGE 1. S80.04 r $8Q.00' <br /> ^ON, f, <br /> ,bATCH3 <br /> .:,,., <br /> croo Std: ,het tI,9na tore from.Cas TOTAL ' <br /> CASH RECD: . - CHECK 0 Ammxlnt Merlap ir:Stell,!onbsty.. . !� <br /> AWA E DISPOSAL IWORMAT1QN <br /> -' VON-RCRA 1 AZARDOUS WASTE,LIQUID(USED QIUMIXED OILS) STATE CODE 221 <br /> NON,-aCRA-]OZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS.)- STATE COD.E <br /> 'ETHER: I _ <br /> DSI WkrED.TSDF: AUUR�}. .■��. „ 5. <br /> ALTERNI>.TETSpF:._ ENI SERV- �RIrB�71� '' I , .. �. <br /> QRUNIS:PIU: EMPTY DRUMS: FACILITY: _ BSC <br /> Mr <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By ehlning Lxlow I hsretryeerfffy that: ' <br /> (Waste oil generator/customer MUST check ONE of the fallowing three boxes) <br /> OY Il l l aye not miscd any of t1l wacic doa4rthcJ�h15ve wllh+ny alhAY IrarSfdnus w ssle,the Molal IuIWeCbnlent is LESS Ilan fAliri pyxn Yrul SFM waslu dors n Jl[nnsnln arty PC41 1 h7v!cnmplled with there(IlAircrM.its of <br /> the applicable California used oil hsanagenmrrs myvlouum to detertnlnu this It tmr_I agreo to accept tlto addldanal[harge•c For the ditposal of this w�isni If the rriftvaiatt"I have pfoviOd ahrnrt this waste Is Irs ghee{ , <br /> •I)Y;I have not rrifrcd any of the wasre deimbedabove with any oilier hazardpuswallle,the.lotal.haldda content Is Uliffl Eft than 1,000 ppm,And thewastq does nol cvillain any POS,I . <br /> hrde fl�'f dad prgvr docssrnir0pnon to World'011 Emrironmoriml Sdtvlces to,rabuStheprosutrrpllonihallhls wnslgwm Owed with otherhyanlous lv,7ATlq I•ssgrrr to e[tpl,l the addllipnal charges fur the llspo�al Or this <br /> ' wa10lf Ihs krfnrmatfnn I ha+rS pryahSed Sbnit ihh syast�h irrconrd - - , <br /> [=:)YAThis waste is from i tarlkwhich rplloetswatte oil ftorn Imitslsold'dis•rl•yoursetl'(01y)6iuvot.eoniik{orlilly eaamnt small4kArilily genet.ator Itt$r quiumes.7a,the hest or my knoMedge,the only.wawt"11'[5i caned <br /> Itirny❑IYICESgG[dllrttia�ilanitffWiyPonsONundlorCdM-l+wrm� lhade'riotmlxidlhl{w?sin ellwilha`ny tBrrfivarslntiwsJaste.orwjgraiHroAil. rsources la9reetoaccept the addlllonalcharrktfnitlRp>ial' <br /> arthls wain if the Inipinnattoo I have p:ri kW abuus 11111 waste is incotiret <br /> (Ail,generators/customers MUST read the following text and cF zkt he associated box.) <br /> EZ3j*If I aitF4 orgecitianto gon trocar•I eentfy that 1 hzi+v a p+agrarn Id place In iedisw the wuNM end iwklty of.wrame rijumialed to the d.greu l Iwave dele+mined to bercgnorsucaHy practicowe vo Thai 1 WA T <br /> seieeted the pran cablifnivittnd of li¢aimen r_+loragt.or dlsposal cvri enlly avaltabir tdrise wtrih�Ich mlWmlzes lho pre srnt And lul ite Ilural to humin life MW Ilse mrlmrimrn4 Qr.If I oma{nail g6isn tlly gonrviiior,l <br /> hasret Jrtdoa gond fAhls efforr Io minEmYrehryry Wal rlriatwn and At&,the holtsi i6 mAha4n o 11 nwilial Dial Is avalwile to mC Shbl ICan efford.% , <br /> ,. 7•IIIs tnrDtidlaal sklning to sho:pacr set forth beltnv on behalf uf�aslonier rkprssrnts and,tratrann thatls¢Ithe has rhe airlhonlytobrisd Curtomoc that ftte Imptno LIEWiptlons ol.waxr and nssrerlal.areltue00 gectuoio <br /> ospackayod,srsarked aria labelcsl.are Ieatly for Irul:nortatdon In occordanrnwith applkallln state and Frdr;tal rcgul'7tlans.Arid lhat.[+tuamer thsll 44sfde And bo h6und by Tire Smnilmdleftm and Coadilkinson IN toversr, <br /> s+de of this 5 Pi V Kv gtdcr. - <br /> Custome�r gnature _ l DateDriverSignat re Date <br /> � � <br /> Print Name Print Drivers Ndme <br />