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i FOR SERVICE CALL: r i SERVICE ORDER PARLIER :'.ASBU EldV1l3lMEN��; SERVICES, DBA FORMNO.WOES004-D (1/17) 559-498-0240 1/{/O 650 i� �'r + 4 SERVICE ORDER NO. t.. FOR ACCOUNTING 1, PODIY 0 NZ423939 562-231- 550 AF 125 - T WORLD IPI L /\ENVIRONMENTAUSERV ICES,. 5 b-"Toewm DODGE INC 14287 EASTNIAtNINGAVE,PARLIER CA 93648 H 3333 AUTO CENTER CIRCLE 1-s$ -1198-6240 PO BOK 8009; P' WWWAVOR_DOILCCI R.-COM D. STOCK ON,CA 95212 �i TRANSPbRTER EPA#CAD028277036 STOCKTON, CA 95208 T ,(209)477-3088 (209)477-3088 CVSTDMER# PURCHASE ORDER# ROUTE O T•ku%# CONTACT NAME ORDER,TAKEN BY HALIDES ST0627 84906 88 SILL Lakela DATE REQUIRED DATE ENTERED NEXT SERMCE DATE.1, ,CUSTOMER EPA.# BILL ofLAOiNG/MANIFEST H 8/17129.17 CA0981967680 PART# DESCRIPTION QTY UNIT PRICE QT•Y P/U TOTAL 55-C/TM - 55 GALLON C1r METAL DRUM'tiltCONDITIONED) 1. $5 .00 X5888 Q4EDMIXED FUELS PER DRUM 1 $226:00 5.0(11 BATa4 Crcr s.Streets: TOTAL CASH REC'D:;;:_'`--_ -- CFI ECK ff RMunt•Manaw,Stavin C3Wtaty..,. WASTE Dl� QSAL INFORMATION, , NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXEO OILS) STATE CODE 221 NON-RCRA HA7.ARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE:CODE OTHER: DEsiGNIATEO TSD ALT>RNA'I-ETSDF: DRUMS PIU: _ EMPTY DRUMS: FACILITY: 8SC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) 0y slgning below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following:three boxes) �N1)1 have not mbxdatiy of the waste describsed4A>M vlth'anyother hazardous waste,the total halide contcnt Is LESS than 1,000ppm,and the wasurderes not confabs any PCOs.I hope complied with the requhenxrnts of the applicable CAlllhmi4msed oil management regulations to dmesmine this is true.I agree to accept theaddltlonal charges for thedispasal of this waste If the lrs(ormmion I have provided about this waste Is incorrect =Ia,Z I hotnotmixed anyof lhrwaste deMFR*daboveWIth any other hazardvMwaste,the Intal h,lide content is GREATUI than Uoo ppm,and the waste does notcorrtbin any PCBs.I lsavcftrwkltd.pr"rd&icumt+rtAi;*nA*Wwkl A tEnrunnnfentol Services to Pubo[the presumption that this waste was m1.M.with other hamidoustrin&m I agree tpattept the aaditlonal chargti for the dhlwsal of this smite if lh#Infdrmatfnn l hpvc oriaA ded•abuut W%wdstc is Int&MCt. MI311A1swasteisfromalank whlclt.collectswasteallfmmhadsehuldRio-It-yours IN01Y)and/or conditionallyetttmptsnallr(uanflygenrruor(CESQG)sou+crs,Tothebestofmyknwdedgp,theonlywasteOconlalned Innary DNICESQGcolleclion tank Is coleyfrom Dlifantbioi MSGmure&0 havenorkied thiswaste oil with anyaiijci hazardnussvaste orw;uie oil fromather sources!,agree usaicept the additinnat chaiggs for dispnwl of this wasteif the Information I have provided about this waste is Incorrect (All generators/.customers MUST read the following text and check the associated box.) It4J If I rim a large quanHry tact era lab I certify ttsol I Is ee aprogrum Inplace to re-duct-1hevolume and IoAkyof waste generated W Ihsz degree I Tuve delrimined io be rcgsomlGilly praCllod le and that I have ,ted the practicalsle method of ereatmenr,ti w,ude,or ttlspowl curre,ntlyovallobfe to me wfikh r0nlmiztslh0 present aful lutnce threat in human Wir.sind the environment;Or,if lam a:null gnamrty generator,I have trade a goad falsh efidA to minlmlrr my wash genrrallon and select thirbest waste nsartOpement nscthtsd that is atwllablC to me that I Can afraid- This Individual slgning In the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer,that the forgoing descriptions of waste and materials are true and accurate as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Cus4Drivegnature Ilse!bound by the Standard Terms and Conditions on the reverse side of this Service Order. 42?/L i n� l?—Z/f 7 et Signature Date `-C rtJCJt Print Name - Print Drivers Name