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SERVICE ORDER FOR SERVICE CALL: PARI IER. - ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) 559-4,98-024&1' Wp•650. - " ' ` SERVICE ORDER NO. FOR ACCOUNTING CALL: WODIY 0 N2540714 �! 562=237=1550 AF 12;5 WORLD OIL ENVIRONMENTAL SERVICES-,,,l s S COCKTON DODGE INC 14287 EAST MANNING AVE,PARLIER CA 93648 H 11 3=i AUTO CENTER CIRCLE 1-559-498.-.0240 PO BOX 8009 P WWW.WORLDOILOORP.COM E STQCKTt]N,CA 85242 STOCKTON, CA 95308 T { � 47T-3813$ TRANSPORTER EPA#CAD028277036 (20911,47741M n C.USTOMER'# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ST0627 ROUTE 124 SCHEDULED4 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST 0 3122J2010 31151/2018 CAD981WOW PART# DESCRIPTION QTY UNIT PRICE- QTY P/,U TOTAL AF ETHYLENE QLYCOL,SOLUTIONS 304 30.00 $0.00 ZW ;. :aGraes:.'13�t. E�hatulr+rti 'casjrr TOTAL CHECK#= k. WASTE DISPOSAL INFORMATION .., .N04CRA HAZARDOUS WASTE,LIQUID(USED CIUMIXED OILS) STATE C008 221 133 •NON-kR"A HAZARbOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE. ol OTHER: 7-7 DESIGNATEDTSDF-, AS11ILRY t �194+Mmgm ALTERNATETSDF: + DRUMS P/U: . ' _ EMPTY DRUMS: FACILITY: A5C, GENERATOR WASTE CERTIFICATION(PLEASE CHECK TH EAPPROPRIATE BOX) 4 signing helaw I hereby certify that [Waste oil generator/customer MUST.check ONE 6f the following three boxes) I l htsvc not ni edany of the Wane any dtheY hazaidoat waste.Ow ipwl halide comlrrn Is LESS than 1.000 pprryand At WoWdoes nor c nttain any KS&I hM complied with the requifcmdras of t aprjlfcablt Ced4wla vwd oll manngsmetnl regulations to determine this Is true,lagree toaccept theatkl It Iona!ctw roes for the dtspasal of Oils was le Kthe InFrimadpn IhAvr proAkdabout this waste is incorrres [� 921 have not mlyed any.od the waste described alwve with any other hazardous waste,the talal halide content is GREAlu 12ian 1,000.ppm,and the Wmtp doet riot contain any PCdS.I have provided.proptir JoCutnwtation to World Oi Lfnvaonmental Services to rebut.the,proonsptl on that this waste Will,mix aft with plh ei hazardous Winsp I agent to;Crept the additional charges for the disposal of this wasle if the information I have provided about this waste is incorrect .• _ - =300Th15.Wiisiols fminli tankwhk i0*4Lhasteoillr6m Ittkt:c hnkS'du li-yoursclf"(DIY)'and/or'torvJi io allyexemptsmalte=uantitygene4Wf(CESQG)sWrecs.To the best of my knowled9eithe only•vuslr oil conr0sed In Ily 6fY1(.i:SQG cdlerilon tank lisslryrrom OlYanN6r CSQG tGuj{e I have not mixed this wane oil ivfthrany other har ardoUi Waste or Wiatc oil(torn other sources,t agree to,iceepl lhe,addiuonal charges for disposal a(this waste If the Information I have pioMed about this waste Is lncorntt (Ali generators/custoiners MUST read the following text and Check theassvciated box.) ti}1111 am a lane nlfbrtlltygtneralor,I certify Thal I ham a W"fam to pure to r¢dusothr volume and to,tclty of vase flrnerrlted tri d1a degrer t have determines!to be monumically practicable and th,11 I have sczl red thr practualsl¢mntsod of srtatriirnt•stmtige,aidlspoial•cumanlly.ci,yllabld to mewlsleh nti Imzr%the premrn Orad Wtwr threat Ialslimiin IIFr 11114 11W.rnvirnnm mt;Oi,If I oma st illrivari ivi i('w tar,t have made a good Wins effort to rnlnlmtzn flit wattr gertCfistyrl AM st)kkt the liiti Y+nstrniatw rlt'rnrpa malhod tlo l{iVikable La.r,♦!'ilfral'I can afford: This Individual Signing in the spite set forth below on behalf of Customer represents and warrants that he/she hat the authority to bind Customer,that the forgoing desciiptlons of vvas!A and mtraiah are%rue and arcurata as pack agedr srmillyd and'labei¢lk are re5dy for tnMpartation In actordanre with applicable state;nil-federal regulations,and that Customer shall abide and be bound by the Standard Teims and Condition on the&Mc side of this Service Order. C uSt �sier Si nature"^ Date Drlv�r. �naildre Date Print Name Print•Drivers Name