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FQjI,SERVICE CALL: SERVICE ORDER
<br /> pr4RWER-. "r- ASBURY (ENVIRONMENTAL SERVICES, DBA FORM NO,WOES004-D (1/17)
<br /> 559-498-p240 wap SERVICEORD>_R NO.
<br /> ,FOR ACCOUNTING CALL:
<br /> 562'-237-1.550 wobw0 N25r. d12
<br /> AF 125
<br /> WORLD OIL
<br /> ENVIRONMENTAL SERVICES,.
<br /> H ��DODGE INC 14287 EAST MANNING AVE,PARLIER CA 93,648
<br /> I 1;559-498-0240
<br /> P 3333 AuT6 CENTER CIRCLE BOX sow
<br /> P WWW.WORLDOIL'CORP..COM
<br /> E
<br /> T STOCKTON,CA 95212 TRANSPORTER EPA#CAD028277036 STOCKTON,CA 95208
<br /> o (209)47.7-3688 (2M 47'-�M"-
<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK.# CONTACT NAME ORDER TAKEN BY,- HALIDES'
<br /> sTQ�27: RUM ta4 SCHE[�IJL D-1
<br /> .. ,.
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA N BILL of LADI NGIMAN I FEST 9
<br /> 4118 2018 40216 CAD881987,880
<br /> PART N DESCRIPTION QTY UNIT PRICE. ''QTMU. •TOTAL
<br /> WO USED OIL I MIXED OIL'S 390 $0.00
<br /> WQSC- USED OIL SERVICE CHARGE
<br /> E!ATLl"
<br /> ..+ ,.: , Get signatum ft rn Casy. TGEAL
<br /> CH£CK# Amt Aftnw.Stare Gd*
<br /> yF r + 'r;+:d ynz, WASTE DISPOSAL INFORMATION'
<br /> .I, .
<br /> r,
<br /> J;RCFtA HAZARDOUS WASTE,LIQUID(U5ED b IL4XED OIL'S) STATE CQDE 221
<br /> +NON RCRA HAZARDOUS.WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE, •'.• '•'
<br /> OTHER,
<br /> ::DES.IGNATED,Trii]F:: FtQhtlA +f ArSSRVICES�CERIa�;tD�MORQ�Frfit�CH�EE>� ,
<br /> ALTERNATE TSDR;
<br /> Li
<br /> DRUMS PILIN EMPTY DRUMS: FACILITY: iiSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHEC.KTHE APPROPRIATE BOX)
<br /> 6y$"IN brI*Wi hereby evnify lhse
<br /> (Waste Oil generator/customer MUST check ONE of the following three boxes)
<br /> :r ni have nut mired ariy of the waatr desc+Ibrd.1bovewth oriyof hut hwardaus w.i te,the total hot 14C con rent a USS than I,Wp ppro,and the waste dors notcorsrala any PCGs.1 have compiled with the,requirements of
<br /> r iipplicable Callfornla usedall loviatioln to determinr thli Is true I c;itec id accept torr add Illenal charges for lho disposal df tht=ora VC If the inImmAinn I have.peovlded.about this waste'Is incbrrott
<br /> (((!,711 I have not tNrodaRYof shpwastedescribed above wish apy Olh'cr harardous waste,IIIc lata(halide content is GIIEATER 1hah,,=ppm,Arid the waste does not c[mlain any PCII s.I
<br /> •64 pr Ojkd prapR documentation so Raid Oil Erivlronrnpnto)Sr+�lces la mbul the prewmptlorr lhst this waste was mUed with other harnlsfous wane_l agree to atcl•ps the esiditlonal,charges for the disposal'of this
<br /> w>str if the lllfarmalStut l have prWkiCd p1so611111!WAsI!}LirrCOtkct , , -
<br /> C1 t33Thlswasle Is from a tank which colftettwalteoll66ni ki.11 01il'do 11•yoursell!'MYI acid/or conditionally exempt smatt gramtity gerseralar(CESOG)tdurces.To the best of my knowledge,the orilywaste nal[onlahted
<br /> in my DIY1C-eSOG collection tdnkfs inky bornOIY 511WOr CES06$Out 01.1 have not mInLd iNs waste oil wah any other hazardwn waste or waste oil from othre sources.I agree to accept the additional ckuttrs larriispasal'
<br /> • •orthis waste if the Information I have provided about this wastir IS Incorrect
<br /> 76 (All generators/customers MUST read the following text and check the associated box.)
<br /> 14)If I dell a large quantity gencralur,I cettlfy that 1 have a program Iriptace to reduce the volume-and to•'chy of wrote genorawd to the•degree I have Jutefmined to be economknlly peactkalrfe and that 1 have
<br /> selected the practicable mClhod of uealmerrt,storage.or Sliipnsahctnrelt[!y r ailable so nit w ich minlmltrs the present and future threat to h;iman,fife and the enrtmpinent;Or,it 1 am a small quantity ge'rspralol,I
<br /> have made a good Will effort to mrntmite mywaitc generation and:elect the best wast¢man,gement mriholf ttsat is available 10 ma that I can afford,
<br /> This individual sl ng In the space sit forth(scfow on behalf of Custornvt represents and wanants that he/she has the authority to bind Cu ha t deur tp it"F of.was to and materials are true and Accu tate
<br /> asp d, r and 1.) M,are ready for tonsportation In xcordanca with applicable state and federal regulations,and that Customer sha rand.tie nil by the Standard Terms and Conditions on the reverse
<br /> Side ft. rllrr-
<br /> /3,/*1
<br /> Custorper Signature Date ver S' stature Date
<br /> Print Name Print livers Name
<br />
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