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SERVICE ORDER <br />FOR SERVICE CALL: <br />PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA <br />559-498-0240 Wo <br />FOR ACCOUNTING CALL: WODIY <br />562-231-1550 <br />AF 0 <br />WORLD OIL <br />ENVIRONMENTAL SERVICES,. <br />5CERTIFIED TIRE &SERVICE CENTER 14287 EAST MANNING AVE, PARLIER CA 93648 <br />H 1-559-498-0240 <br />P 1131 HOLLY DR WWWWORLDOILCOR.P.COM <br />TRACY, CA 95376 <br />(209) 835-6900 <br />TRANSPORTER EPA # CAD028277036 <br />f II <br />FORM NO. W6ES004-D (1/17) <br />SERVICE ORDER NO. <br />N2415168 <br />I <br />CERTIFIED TIRE AND SERVICE C <br />1875 IOWA AVENUE <br />RIVERSIDE, CA 92507 I <br />(951) 369-0025 ; <br />CUSTOMER # <br />PURCHASE ORDER # <br />ROUTE # TRUCK # <br />CONTACT NAME <br />ORDERTAKEN BY <br />HALIDES <br />CER626 <br />86 3 o•Gf /Y <br />CHRIS <br />adavis <br />DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA # <br />BILL of LADING/MANIFEST # <br />8/2/2017 <br />CAL000396501 <br />PART # <br />DESCRIPTION <br />QTY <br />UNIT PRICE <br />QTY P/U TOTAL <br />50EL <br />BATCH 0 <br />Cr0 <br />50/50 EXTENDED LIFE (PER GALLON) <br />U 7 %/ -7 <br />5s Streets: <br />55 <br />6 <br />TOTAL <br />CASH RECD: CHECK# <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIVMIXED OILS) <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />OTHER: <br />STATE CODE 221 <br />STATE CODE <br />DESIGNATED TSDF: <br />ALTERNATETSDF: <br />DRUMS P/U: EMPTY DRUMS: FACILITY: <br />BSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />By signing below I hereby certify that: <br />(Waste oil generator/customer MUST check ONE of the following th�boxe_s) • _ <br />MRl) I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than 1,000 ppm, and the waste does not con rGany PCBs.rha o' p1 a wit tY)� r q�u mems of <br />the applicable California used oil management regulations to determine this istrue. Iagree toaccept the additional charges for the disposal ofthis waste ifthe informItionIhaveCCp111ro��vi++dedabd&teeeh�tty�t�'s`tei 6orect <br />OG2 1 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATEN than 1,000 ppm, and the waste does not contain a pp I 19 p <br />haveprovidedproperdocumentationtoWorldOilEnvironmentalServicestorebutthepresumptionthatthiswastewas-mixedwithotherhazardouswaste.Iagreetoacceptthea ��••i((iona char e r h disposal ofthis <br />waste if the information I have provided about this waste is incorrect �,y <br />•- nJ :.....,... <br />�If3) This waste is from a tank which collects waste oil from household'do-it-yourself' (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To hebesCoF•myknowledgerthe.00ly'.i+'t3ifetiil, ontainec <br />in my DIY/ CESQG collection tank Is soley from DIY and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste oil from other sources. I agree to accept the additional charges for disposal <br />of this waste if the information I have provided about this waste is incorrect <br />(All generators/ customers MUST read the following text and check the associated box.) <br />C=#4) If I am a large quantity generator, I certify that I have 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 <br />selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment; Or, if I am a small quantity generator, I , <br />have made a goad faith effort to minimize my waste generation and select the best waste management method that is available to me that I can afford. <br />This Individual signing 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 <br />as packaged, marked and labeled, are ready for transportation in accordance with applicable state and federal regulations, and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br />side of this Service Order. <br />C , Signature Date Driver ignature 3 aD to <br />P5 �� <br />Print Name Print Dr— iv— erss ame <br />