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F011 SERVICE CALL: SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES , DBA FORM NO. WOES004-D (1 /17) 559-498- 0240 WO 250 SERVICE ORDER NO. FOR ACCOUNTING CALL : WODIY N2565733 562-2314550 0 AF 150 WORLD OIL ENVIRONMENTAL SERVICES ,M H PREMIER CHRYSLER DODGE JEEP RA "73 EAST MANNING AVE, PARLIER CA 93648 P 3460 NAGLEF ROAD 1 -559-498.0240 3480 NAGLEE ROAD P WWW.WORLDOILCORP. COM D TRACY, GA 95304 TRANSPORTER EPA # CAD028277036 TRACY, CA 95304 T ( 209) 820- 1815 (209) 820- 1415 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES PRF147 ER-86 Ziol9 MALENIE avelazquez DATE REQUIRED DATE ENTERED NEXT SERVICE DAT//E t CUSTOMER EPA # BILL of LADING/MANIFEST # 4/24/20118 CAL000385003 0 / 77 < 3 PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 55-CITM 55 GALLON CIT METAL DRUM 1 $52. 00 $56418 MIXED MIXED FUELS PER DRUM 1 $225 • 00 $225. 00 EPA Inacth l no drum waste pickup BATCH R _,_ -. Ciro ss Streets: wo n/a TOTAL CASH RECD: CHECK # Amour* Maniii Steve Gately WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS ) STATE CODE OTHER: DESIGNATEDTSDF ALTERNATETSDF: - DRUMS P/U: EMPTY DRUMS : FACILITY:_ _ BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: ( Waste oil generator/customer MUST check ONE of the following three boxes) Or 1 ) 1 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 contain any PCBs. I have complied with the requirements of the applicable California used all management regulations to determine this is true. I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste Is incorrect [=#2 1 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 1 ,000 ppm, and the waste does not contain any PCBs. I have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. I agree to accept the additional charges for the dlsposal of this waste if the information I have provided about this waste Is Incorrect ON3) This waste is from a tankwhlch collects waste oil from household 'do-it-yourself" (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my knowledge, the only waste oil contained In my DIY/ CESQG collection tank Is Soley from DIV and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste all from other sources, I agree to accept the additional charges for disposal of this waste if the Information 1 have provided about this waste Is incorrect j (All generators/ customers MUST read the following text and check the associated box .) Kle it f am a large quantity tionetalcer, I civ illy that 1 have a program In place to reduce the volume anft toxicity of wa•.tu genenited to the clert I have determined to bo Konomlwlly practicable and that I have tedthe practicable method of treatment, storage, at dlspasal currently availibe to me which nithhnites the prexua and future threat to human life and the environment. Or, IfI am a small quantity generator, ) haws mark a good (anti effort to minimize my waste generation and select the best waxc management fnethod that Is avellablc to me that I tan afford. This Individual sl ninq 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, rt)ked 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 s e7fh(s Sir Order. Order. r C _ ` - ' ftsf �r Sin Lire Date Drive� cr i �� Prin`tlame Pint er e