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FOR SERVICE CALL: SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) 559,498-0240 vVU 650 • . SERVICE ORDER NO, FOR ACCOLINTING'CALL" pnl r O 562'231=4550 N2375639 AF,125 WORLD OIL ENVIRONMENTAL SERVICES,. H STOCKTON DODGE INC 14287 EAST MANNING AVE,PARLIER CA 93648 I 1-559-498-0244 p 'i333 AUTO CENTER CIRCLE PO BONG 8009 p. wwVv.1NORLDOILCORRCQM•• T 5TocK7QN,CA 95212' TRANSPORTER EPA#CA062827706 STOCKTON,CA 95X6 o (209)477-3668 (209)477-36a8 '.CUSTOMER# PURCHASE ORDER It ROUTE#. TRUCK# CONTACT NAME. ORDERTAKEN BY HALIDES 510827 3 124 iCMDl1Ll`f `i DATE REQUIRED DATEENTERE6 NEXT SERVICE DATE CUSTOMER EPA# BILL of LABINWMArNIF8T,4 5/76/2017- 5/261201.7 CAD981 967680Z6-c56aIUK' PART# DESCRIPTION CITY UNIT PRICE ' . 'P/U, TOTAL USED:01L/MIXED.OILS VOSG'; USED Oft;SERVICE CHARGE 1 X80,0(7 . $80.00 screeds: . . ., raTAL C.AS4REC'D1 CHECK H WASTE DISPOSAL lNFORMATION NON-RCRA.F IAZARDOUS.WASTE,LIQUID(USED OILIMIXED 00) STALE CODE 221 NON-11CRA'HAZARDOU5 WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIO,N5) STATE CODE OTHER. X DE IGNATEDT51DR 88t1R1�Eisi!/IR�3NNfIwMf�it�EFMC��Rla�i9�[f A3C7RC+1R�171T CI=R��i:A�S�{217Q}�t=t823;dIL0i3�39368Q. ALTERNATE TSDF: DRUMS P/U: EMPTY DRUMS. FACILITY: .. S.SC GENERATORINASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) Hyslrjn1r19hClowiherrhy[crlFfyfhal[ (Waste ail generato0customer MUSTcherk ONE of the Following three Foxes). _ q1]I have not rd%iEd,tr/y Uf 1he wasta dm! ,,bcd oWva wnh a.ry[Thor hatWdrwr Wilfir•Iholowl hallite canlCnt It L✓:SS'th+n I'ma ppm,wi%l the waylc docs riot Sontain any PC bt.I hone compltcd with the rr•iwremanst n! haMIIcablr.Ca4femia used aM•martagcrnenl for ihedlsfshsaf orihit wane Ir11101nrormatton I have proMed about this viasw is incorrect . M021have notmbtdarlyaFthe wa,to desrnEcdibo-,ewiihar/other hatartloos waste.the total halide conlentIsGIIEATERthaol,ODD ppm,and thewaste does not conlalnally p0s.l helve provldr,J propr;rdgcumrnta[iun[n1V9dgl(Js1,Fnvhgn[nenla1 Services to rchul else preuunptlon that II,IssvSstcw.0 mlved with athrr hamddout waffle,I pglce to adept the,iddidonnl Chantel for th o dlsposat of 0M ast we If the Information I have pr6lded abput ells waste is incorrect - +31TltilwastdIII Gumstankwhich eolfeclswzlood'Gumholneholddolt•yourscif'(D[Y)atfUmeondnionalF/eMemp(smallttuansity'rVnmglor(CES061sourco tothc.bestorn.yknowledt[e,theonlywasteoilcontained 1n my Oly/CFSS3ri'(didc Sipi fanM IS sarsy Item Div andior CCSB squtce%1 have not nsived lhl�[WAsteell Vrilh anyr,1119Yhaxuteklu¢wailo'nr haste ell fra+ritssher savrcesa anree td accept the additim,ai chafges for dl+pnsal of%Ni Wasted the Infonvinllort I havcp(w rlr4l.tbvtll ihli vr;lrle d in[ts tv<c (All generators/customers MUST read the foll"ing text and check the associated box.) " ++1 I!I a a 1.11 lie guunlhy 4)nnrratnr,I carliFy Ilsol t have a pras�iam in place in Mdtire the viNurnamid Loxlclty of waste Denerated to the degree[have dcicdmlned w be"atlemically praclicahle and that I have eClrM il,a pranks bleoll matl a(ucatrsnrni,sturx+e,at dl t"141 cut whtly Seal lnWe itse- mwhieh ripIrnf olh�}pleb[anm d(ptury Oofvbi ro hpnt4n life an tl tNe env+mnrneylk or,If I aain At gtranhty rlcrrerator,I 14 rl'tad!Ygg6d Witt of(*,I to nunIrwit nye Was#rjeno.nion am)wtoci Iho:beit w,Hf4 tyre 11 managpr;wa modiod that ii'.rilIUJt1}C to a I ran alfard; - "!1111 indlnllhwl ilDnl19 In the spa,e tel for in below n1i hot:df of C%Atomer Icpre senit and wan.ints that herslte has the authority to bind Customer,ihatthe fmgskng descriptions of w.r;te and neuerlals are true and accurate Ss packager/marked and IaL•eled,arc ready for tran,.Wi a t ion inxcordance wish jppl;cable state and federal r"vWonf,and shat Customer shall abide and ice bound by the 5tandird Term:and Cnndillnns on the inverse side oft his Service(hder. �z7A Customp.ir Signat l Date 0 ' er 51 Da IF Print Name Print Drlverx Name