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FOR.SERV!V CALL: SERVICE ORDER <br /> PAF7bER— ASE3URY ENVIRONMENT�LL.S1x} VICES DBA FORM NO:WOES004-D (1/17) <br /> 559-498-0240 V1f0 850 SERVICE ORDER N0. <br /> FOR ACCOUNTING CALL•WODIY 0 N2363243 <br /> 5G2=231-15�( • <br /> AF 125 <br /> • llll■��O <br /> RLD OlL <br /> ENVIRONMENTAL, SERVICES,. <br /> H STOCKTON DbWE INC 14287 LAST MANNING AVE,PARLIER CA 93648 <br /> 1 1-559-49B-0290 <br /> a 33 'AQTO CENTER-'CIRCL F- :. . PO BOX$Ob9 <br /> E WWW.WORLDOILCORPCOM <br /> 01 STOCKTON, CA 95212TRANSRORTER'EPA#CA0028 ?7U36 STOCKTON, CA 95208 <br /> T.(209)477=3gB8. . (209)477. 888 <br /> -CUSTOMER'# PURCHASE ORDER Y ROUTE II TRUCK# CONTACT NAME ORDERTAKEN:BY HALIDES <br /> ST0827 88 Z ZACK squIrIttana <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE wsto rfER EPA A BILL of LADINWMANIFEST 8.' <br /> 5M201.7 6,0681887480 <br /> BART 0 DESCRIPTION QTY- UNIT PRICE:' •QTY P1U TOTAL <br /> 55-C'.1TM'. 55 GALLON,Cq METAL DRI)_M (RECONDITIONED) .$52k0-0 f $58:88 <br /> LABELS,FO 41X FUEL CJ4SAXr SEL 80CH ItR <br /> TOTAL <br /> CA5H AEC-'Dz CHECK,# <br /> 'WA5TE D15POSAL INFORMAT101!f F <br /> NON RCPA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS). .STATE'CO:DE 221• <br /> NON,8uR F zARDQUS WASTE,UQUID(ETHYLENE GLYCOL SOLUTIONS), STATE CGDE . - . <br /> OTHER:----.. - - - <br /> DE51GNATEi T'SDF:_ <br /> ALTERNATETSI]F: <br /> DRUMS PIU: EMPTY DRUMS:- FACILITY:_, RSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> by signing below I hereby certify that: <br /> (Waste oil geiler:ator/customer MUST check ONE of the following three boxes) <br /> l <br /> a 0 1 h?ve not rallied any of the trwst deicutted ahoy a wll It any rr1ltct ryl7Md+lmW.ssir,I Ifr l nil[Niride coolcmI$LF.SS I""1.0W pp!r"Fkt IlsQ waste d osi"tdoUln any PCfis,t}s.suo complied with the recItgrvmontsor <br /> t ha Applicable Un farnlaused oil nun bclement rovubilofts todviefns,nethis.istr�..Ioillmtoaccept'lheatklldnnatchar9esforTho dhpoialortliiiw4ata lthtrWormaOnlhoveprovtdcdahoutthiswasteisincorrect <br /> �I121 firi not raised any of.the waste dascnlmd+ibri vR wll h any at Is of haiardous waste•the fatal hallde conte ni IsGREATE R ihsn IDM ppm,and the waste davi not Rantatn any JIM.I <br /> have ItfeWdod proper documanladon 10MI kl011 Emputoocru.+l Scn•ices,ty,rebut the p�em+n?prion d?al this waste waf ml„edvrhfl Mhta ha.ardguswasle-I agrre to aetTpi rho adJitlopal ebarfles for the disposal of this <br /> wdsril if thrktl+utiynlfonl havr iripvklerlghoul ifriy w.ntr 15 kiconect <br /> =113yThlewaLtd'A from ittank whktitolloefswastRolilfnrplswwhok! !n-IS•yqunclf-101Yland/or cgnditianhllyexampiirfailrgiantfly,gMMaIDnMR54G1soVlielTnthe bustulinykfe tdgq,il,Konly vialleollconlalned <br /> lrf'rity[]l yl 015 Gco3k Tian tank st ivw horn WY aodro=CEiQ :cure;•s.t Nve riot tailed thiswast a Oil with arty isthri=1.11}I waIto or iv tq dl from oltiv sources I agicr t�xccptthc adilltituial charrycs for dlspo:al <br /> of this wasto'Irlhr,sJwfrutinn I is>tve[trovr+ied abpnl shL waste is+nchireel <br /> (All generators/tustorrlers.MUST react the.following text and chetk the associated box.) <br /> Qat If t aa fair gny.ny f <br /> ilenaater,I ctvtlfy thal I haves it prufnvm In pI?ce to redpcethes-olume and tc.utBy W walla gtVlerJlcd to thedc?per I hive de;crmfrrpd}o bc,xonornl[ally praerleiWe nndthat I hivC <br /> ...l lrxltcl lltr,i+rictirnbio tneihod of im.itun:nf,storm},.or disposrl tunrvuty w.%llable to nra Wlllsls tat+nlnurY's llxt p[N.7111 Mrd lYrurtilufrJE t-rltulnap the and diaillfwrvrlhH'111;Or.if I sr/10 5tttall ry11,t151ttY IJt'n1;rJlw,l <br /> AIR ` <br /> Itava made florid l+iIIh riforl to rhlntrntu my whits ytnrnntluiJ d iietecl ihrWit iwnte ritlna{tMsrnl mothod that is avallablrw'lrs!dial!Can alfatd• <br /> Thl1 individual signing fn d,e:pace set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Cfth1li <br /> ang Jtdpelons or Waa1t:and materials are true,and accurate <br /> ;II pockaged,rr wriond and labcled.mc ret,dy far transportation in accordance with applicablestate and.federal regulations,and that Custobniind by the 14ancMrd Tams and Conditions on the revers <br /> sidcul 11111 sclvk'e 0nfer, <br /> 1 <br /> !re ! + afe� r;-3;'(] '� a Te <br /> rPrint'Name Pre <br />