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FOR'$'VICE CALL: SERVICE ORDER <br /> PARLIER I ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> ',,•559.498'.02.4.0.. . Wd 650 SERVICE ORDER NO. <br /> FOFt ACCOUNTING CALL:' VV00fY 0 <br /> 0 <br /> N25=71562-237,-1550 <br /> AF 125 <br /> ENVIRONMENTAL SERVICES.,. <br /> S 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> STOCKrON DODGE INC <br /> 1-559-498-0210 <br /> P 3333 AUTO CENTER CIRCLE P0 box 8009 . <br /> 6 WWW.WORLbOILCORP.C.OM <br /> T ST0CKT0N,CA 95212 TRANSPORTER EPA#CAD028277036 • STOCKT-ON, CA 95208 <br /> .•(2091) 477-3068 (209)471-3888.• <br /> CUSTOMER# PURCHASE'ORDER# ROUTE# TRUCK# CONTACT NAMEORDER.TAKEN BY, HALIDES <br /> STD627 ROUTE 124 Yo SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED--. NEXT SERVICE DATE CUSTOMER EPA 8 BILL of LADING/M,ANIFEST#. <br /> 4/271201041,202018 . CAD98198700. + 2-0 <br /> -� <br /> PART# DESCRIPTION- QTY UNIT PRICE. QTY PIU. TOTAL <br /> WO LJSEO:OIL1 MIXED OILS 390 $0.00 <br /> WC)5C USED fll,L,SIrRV�CIc CHARGE '! $80r48" 1 $8400•. <br /> BATCH <br /> "Crc S� 'Ret Ogrletua er from Cosy, TOTAL ' <br /> CASH REQD:• CHECK#.: Aams t 1411uta9er:rSbwo ftWy <br /> " WASTE DISPOSAL INFORMATION <br /> NQN-krRA HAZARDOUS WA$TE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON•RCRA RAZARDOUSI ASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) . STATE C-0P <br /> OTHER, -- -- <br /> DE5IGNATEC775L}F: ��I CIVfEIiPA�B��1>'ILBtifyIVlBit�4H}$CE�RfFrir! , <br /> ALTERNATE TSDF: <br /> DRUMS PIU: EMPTY,DRUMS: FACILITY:. BSC - " <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By'sighing below l herebecerlify tha L• <br /> (Waste ail generator/custonner MUST check ONE of the following three boxes) <br /> � I have not(mired arty bf the waste desetihad abovo with any mho I1a2Hdrill p <br /> tiul waste.rhe lalotbalide contant i%LESSthan),drill ttw waste din notcoritafn any PCOa I KTM ronplled with the reg6kerncnts of <br /> the appliiable Callfomtu used oil managernem irviAilom io,dti"Itte this)&rrYe.I a ggivoto occepl.lhe adr.Ntionul tharrges,for lhvdlsposa o4h4waste lf'Ihe mforncrtlpn l have pirrOded about this waste is Incorrect .. <br /> C1e21has?cnotrNeudanlorlhowa:icdcudbelalsovawilhAAyothcrhazandouswaste,Irowlhalidecontent isCAEATERthan 1,000ppm,and thevemlodoes nor comdlnanyXgs,I <br /> hate prrlOdO proper dotvmenwilen la Wodd Oil Fnvh W menial Services to rebut the presumptlon thatghis waste was mired with other hazardous wasir.1,agree to otupt the addillonal charges for the disposal of this, <br /> waste li tlfevdormatl4n I haveyxavfded aboll(lhilt WAM h lr6li0nd t <br /> 1 <br /> ba3STftli was le Is from a tank which Sotlacts waste ail from household tlo-it-yourself•(DIY)and/or cond itiona llyexempt s mall rtsr.sntity gene,a rbr IC ES4G)soul es.To the best my knowledge,the only wa tit oil csriolilrod <br /> In mi fRYI CFSOG collection rank is retry from DIY and/or CESCIG lthticrs.I have not mixed this waste oil with any other hazardous waste orwasre oil from other sources.I agree toUcept the additional charges for disposal <br /> of this waste if the information I have provided about this waste is Incorrect <br /> �� (All generators/cu5tomers MIDST read the fol lawing text and cheek the associated box.) <br /> i';14}If I am a lartle quantity generosot.1CMl ify that I have.a program In plur,'e to avllw,'r the votynl and moiclty of waste qe ne mind 14;11w deg tee I have dein mingd io be.anorak ally p aorta bre and that I have <br /> selected she prix ucmo method orliol mens.yiora9o;er.dl%pGtai Cllrr$pt•1 aYaltagrC lgyllp Hddclr nlinindrrs tire,rn8srpt ami NJHr4'1lwrat I lNatult Ilfe and I ht•knWIP lntrn"R.Or,I F l am N small quanl try fnderalrr"1 <br /> Fiats mad"a grind Wilt afrprl m tnlnlrniY4 mywastpgehrration mW select the lieu waits managm"Al mrihod skis Is"Pilobir la ms Thai I can afford. •, <br /> This individual signing in•the%pace set forth below on beholr of Cunomet represents and warrants that hehhe hat etre awhuri ty to binJ Customer,that the forgoing descriptions of waste and materials ase nuc and accsuwe <br /> as packaged.marked and labeled.are ready for transportation In accordance NTT applicable stare;md federal regulations,and that Cut comer shall abide and be bound by the Standard Terms and Carsdiilant on the revel se <br /> side of this Service Older. <br /> � � G <br /> Ckistomet- It3nattire Date DriverSignatureDate <br /> rr V <br /> Print Name V Print Drivers Name <br />