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SERVICE ORDER <br /> FC14�SERy10E CALL: <br /> P fiLr�R ASBURY ENVIRONMENTAL SERVICES, DBA FORMNO.WOES004-D (1/17) <br /> 559-498-0240 wo 650 SERVICE ORDER NO! <br /> FOR ACCOUNTING CALL: <br /> wooly 0 hl25afj403 <br /> 562-231-1550 <br /> AF 125 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,, <br /> H STQC{CTC11V DODGE INC 14287 EAST MANNING AVE;P.ARLIER CA 93648 <br /> P 3333 AUTO CENTER CIRCLE 1-559-4980240 PQ K.X 8" <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> STOCKTON,CA 5521.1 TRANSPORTER EPA#CAD028277036 STO(XTON, CA 95208 <br /> 0 (209).477-3068 - .(209) 477-3888 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME. ORDER TAKEN BY, HALIDES <br /> 8TO827SER-88 KC �vfalazquez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# - BILL Of LADIINGIMANIFM# <br /> 4110/2018. . 71' G1Jj, <br /> PART# DESCRIPTION' QTY UNIT PRICE.. QTY P/U. 1. TOTAL <br /> 55-OtT'M '55 GALLON Ofr DRUM(IRECONOITtONED) 1 $52.40 $58.68. . <br /> OILY.50 OILY,SOURS K.R DRUM. 4 $165.00 r $BBE1r00 <br /> �YCH <br /> Cm Fs 5tree4 :' Get sl naWrb 1Yl'nm C.asy: TOTAL <br /> CAST.{=REC'L7:,. CHECK Ala+omt.Mniter,Steve.Gdej <br /> WASTE DISPOSAL11�*ORMATIQW <br /> { N&-RCRA HAZARDOUS WA5,TZ,LIQUID(USED CIL/MIXED OILS} STATE CODE,22i-- <br /> ;.rJON-RCRA HAZARDOUS WASTE 11QllID(ETHYLENE G.LYCO.L S.pLUTIONS), t STATE CODE, +(' <br /> OTHERi <br /> L7E51GNPif E'[7TSDF� .r . - .. ... - 'i ,1• r <br /> ALTERNATE TSDF: <br /> DRUMS PIU: EMPTY DIiUM5: FACILITY: 35C <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> ityI!in i ng twksvr l her city c cz tdy that' <br /> (Waste ail generator/customer MUST check ONE of the following three voxes) <br /> CTM I haver nal mi-cd any W the waste destrshed abmrswlt any udstrluad iotts wassc,thr tato{haiidecont of H LC-55 than 1.0M ppzn,and the waver Lim not conudrl any PCU.I hxrc coritpliedwiih:itle ret orements'nt <br /> rhe appkaltla C vhforrlla"I o4 tnaaaglKnoru regularlont:to aetrrmine:Oils la Inm:i oghe to4mcepr theaddilion.sl dirges for the di;noul ofahis wnsteit tho inform askn Itme provided about thls wane isin[otntci ' <br /> =o;,l ham not mi,L d a-y.orihc envie descried abovr withany Other 1taaaldnut wasou'lhe•lotalhalide CGhlcni is GREMER than 1,000 ppm,arid the wAt1C docs notcom.2in any Pcos.I <br /> hav$ptovWrifproperdocumenwllnnmworldOdEnvlronmrnaisatv15*�vrrkw�hepotirL)ptlohthatthitwastewasrniaedwith other hazWouswastelallmetoxceptthe additional charges for,the dlsposa!'O ihis <br /> WPttE it lho lnrmmannn f'havo p{ovldgtl aiHtot this wade.r rn[OnlY3. , ' •• , <br /> EMirll Tli17watto is from a tank whkh collects watlo u11 from fwtnchulq o igyaursia�'1�t1'1'apdtw eonditit rally exempt small quawlly generamf(CE54G)i"es,To the best of my knmvledge,the only wattu cl!iilhlalned' <br /> in myfivCEM cvlleciwn rank Is Woy.rranAly andfor[EM6 sowrcm-i Bade hok mlaed th6 wane a$Mih any other hiiaulat+t waslb or waile,011(P aiher sources-I agree m rept the additional diaiggs.ror dss W.I <br /> of Ifrt,wall if Ute ororrinaili n Ihow provided abaot thls wash it incorrect <br /> (All generators/customers MUST read the following text and check the associates[Liar:) <br /> dl it 1 oma large rtuanhty!Wrsrralor,I ectlify that s haws a fgegramin pine to*ore live votutnr end lu.tciiy at watitO ryetleraled tO Ihcde9ree l hat,Qdyternfned to be ccunomhally practicahle and that I have ^" <br /> rlMted the practic4bte tans od of tical mt:hl,%wage;w dlspalarcmressdy rwaltable.tO 1"which mtnlmims(he mOrnt Zinc fulorr threat to nurnan lrre AN)the envi:bnrrrenf;N.it f am OaunaR quan.Ty!rife neralor,l <br /> Nva made a good rukh elfwt 10 11ilnlrn4e my wakr Ortaimltm and srltkt ihr.best waste man agrmCnt Method that k awllaw la me that kern afrtm& <br /> t <br /> This individual signing In the space set forth Wow on behalf of Customer represents and wnrrariis that he/she has the authority to bind Customer,chit the hp my desulplions of waste and materials are true and accurate <br /> e,,knd labeled,are ready for vanspoiiation In accordance with applicable state and federal«gulations,and that Cuslomer shall obidels r hound by the Standard Terms and Conditions on the reverse , <br /> or, 1 <br /> 41ZtDate Driver ITatuPrilht Dlive6 Name <br />