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Jan 03 20 02 : 39p James 2099481693 p . 2 FOR SERVICE CALL: SERVICE ORDER DARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-D (1 /17) 559-498-0240 SERVICE ORDER NO. ;OR ACCOUNTING CALL : 562-2314550 WORLD OIL ENVIRONMENTAL SERVICESIM S 14287 EAST MANNING AVE, PARLIER CA 93648 1 -559-49B-0240 P E WWW.WORLDOILCORP. COM r T TRANSPORTER EPA # CAD028277036 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA $ BILL of LADING/MANIFEST # PART # DESCRIPTION QTY UNITPRICE QTYP/U TOTAL r - t TOTAL CASH RECD : CHECK • , , WASTE DISPOSAL INFORMATION NON- RCRA HAZARDOUS WASTE, LIQUID ( USED OILiMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID ( ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER : DESIGNATED TSDF: ALTERNATE TSDF Li DRUMS P/U: EMPTY DRUMS : FACILITY: BSC GENERATOR WASTE CERTIFICATION ( PLEASE CHECK THE APPROPRIATE BOX) By sign Ing below I hereby certify that: ( Waste oil generator/customer MUST check ONE of the following three boxes ) = # 1 ) I have not mixed any of the waste described above with any other hazardov_s waste, the total halide content is LESS thar 1 ,000 ppm, and the waste does not contain any FCBS. I have ceinplied with the requirements of the applicable California used oil management regulations to determine this is true. I agree to accept the additional charges for the disposal of this waste if the information 1 have provided about this waste is incorrect x# 21 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER thar 1 ,000 ppm, and the via ste does not cocoa n any ?CHs. I have provided proper documentation to Wood oil Environmental Services to rebut the presumption thatthis waste was nixed vvith other hazardous waste, I agree to accept the addhienal charges for the disposal of this waste if the information I have provided abort this waste is incorrect =1 #3) This waste is from a tank which collects waste oil from household "do-it-yourself" (DIY) and/or conditionally exempt small quantity generator (CESOG) sources. To the best of my knowledge, the only wanin oil contained in my DIY/ CESOG collection tank Is soley from My and/or CESCIG sources. i have not mixed this waste oil with any other haza "dous waste or waste all from other sources. I agree to accept the additional charges for disposal of this waste if theinformation I have provided about this waste is incorrect (All generators/ customers MUST read the following text and check the associated box.) =3 #4) if I am a large quantity generator, I certify tnat Ihave a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to mewhich minimizes the present and future threat to human lifeand the environment; Or. if f am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me that I can afford. This individual signing in the space set forth below on behalf of Custome- rrepresents and warrants tha: he/she has the authority to bind Customer, that theforgoing descripronsof waisteard materials are true and accurate as packaged, marRed and labeled, are ready for *.ransportation in accordance with appl'cable state arid federal regulations, and that Customer shall abide and be bound by the standard Terms and Conditions on the reverse side of this Service Order, Customer Signature Date Driver Signature Date PrintReceived Tirie Jan , 3 , 2020 3110PM No , 5767 Print Drivers Name