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FQR SQRVICE CALL: SERVICE ORDER PARLIER ASBURY ENY,IRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) 559-4.98-0240 wo 050 SERVICE ORDER FOR ACCOUNTING CALL:VV( )DIY 0 1`42372918 562-231-1.550 0 AF 125 -WORL '0 L ENVIRONMENTAL SERVICES,. S H arOCKTON 000(33t-INC .142.87 EAST MANNING AVE,PARLIER:CA 93648 P3& '1559-45i8-0240 PO BOX 8009:: 33 AUTO CENTER CIRCLE E WORLDOILCbRF.COM Www- D T 81-OCkTON, CA-.95212 TRANSPORTER EPA#CAD028277036 sToQKrbN,'C*A 95208 o (209) 477-3669 (2091477-3688 CUSTOMER# PURCHASE ORDER:4 ROQTE# TRUCK# CQNTACT NAME ORDER TAKEN BY HALIDES ST0627 -86 TA$ATH6 avalazquez DATE REQUIRED DATEENTER,ED NEXT SERVICE DATE CUSTOMER EPA III, BILL of LAOINGIMANIFEST P 6 - 9?,;79 JJ PART# DESCRIPTION QTY 'UNIT-,:PRICE: P/U, TOTAL 55,C/TM 55 GALLON.W METAL DRUM (RECONDITIONED) $5z 00, s5e.68 MIXED MIXED FUELS PEI I .DkUMi MTCH,i Crbs 5 steet& TOTAL.. . CASH.REC'D,._, CHECK# WASTE D5POSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID.(USED blUMIkFb OILS) STATE'CODE 221 NON-RCRA I]AZARDOUS WASTE,LIQUP(ETHYLENE GLYCOL SOLUTIONS) STATE CODE bTHER: DESIGNAItDTSDF: ALTERNATETSDF: DRUMS P/U:— EMPTY DRUMS�- FACILITY:—_ BSC--. L GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) ry signing below I herchy certify that: (Waste oil generator/customer.MU ST check ONE of the following three,boxes) =#I)I have not mixed any .ff,;am;vrsfliMSrIsAri f.DDO Ppinr and thtw4ito ijws not comlAirs any'ClIsJ hw-conipliedw'ith theie'uirement sof 0 q, . . the applicable California used oil rnaim9onwrit oeqvlatlwi M tictumW thil it Iduo.I 2rwo to4ctoist for the 44porial C4 INS Waite If 1�,,fillumToCon I havc pmvided about this waste is incorrect =#2 1 have not i7flxed'any of the waste described above with anyoIher*h3zardous'wasse,the total halide content is GREATER than 1,000 rions,and the waste does not contain any PCITS.I have providealp ruser,documenta(ion to WorJd,o!rEn,vIrcmrn-cntal,Services to rebut the pfesumption that thls.waste was mixed with ot.11pr hazardous misle.I agora to accept the additional charges for,the disposal ofthis i waste ifthpinformati n I have provided about this waste is in cagect .0 =11'I-'This v;ass4k from a tank which coll&tsvv.istckill-f{cym h(juseNoWdo-it-yourself.-([)IY)and/or c6rditio I nally exempt small quantiTy gen4hator(CESQG)wikcs.io the bes'of my knowledgk%166 only WaiI6 oil contained in my'01Y/CEM2colIlion CanIt is softy from DlYalm9cir CESQG towceS-I have not mixed this waste oil wi(liany Other hazardous wak te or waste Oil from Offiff mU[Cic{.kigrep 3o accept-the additional ch'arge0or d[`Sfs&tal of this waste if the information I have provided ab.pUtttills waste is incorrect (All generators/customers MUST read the following text and check the associated box,) I haM aproorramin(Axt,'.O.Vdjjw be vaiumvnd it,h 2i ty or"sit:go,k-rjIvJ us 9le d F.Vr r j Iw%V dlcrmlncd to 6"tianonikalty pira cticable and thatlhavo grlr ked 0w pmoltaW rshod efirowmim.%iuw0v;of disposal ittIno!illy awlittle tonsawhich ininlnitres the ripcirrit PhKI furute throat iv hLinlain file arA the enviiunit=Or,flarts o P"y Wall w7neratlarthod mvilitsclifiat Is aVallable IQ rnelhoki Can Wood.' This individual signing in the spare set Forth luclowon behalf of Customer represents and warrants that he/she has the authority to bind Customer Ihaltl^ 5,m- descriptions of waste and maleiUltxo true and accurate as packaged,markedand labeled,are ready for transportation In accordance w1thappli-ble stale and fe.demlreg,lalions,and that CustomtJ,i shall nlr• xwli:n oegn)by the Standard Terms and Conditlont On the revery side of this Service Order. std elr5ir} Drive I re "are IL I �� Print Na 1f' PU Drivers Name