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FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES , DBA FORM NO. WOES004-D ( 1 /17) <br /> 559498- 0240 WO 250 SERVICE ORDER NO, <br /> FOR ACCOUNTING CALL : WC) IIIY <br /> 562-2314550 <br /> All: 150 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICESIM <br /> H PRL-, NIIFR ( : HRY131 ER DODGE s ) FEP W, W§rt EAST MANNING AVE, PARLIER CA 93648 <br /> p 3460 NAGLFF: ROAD 1 -559498-0240 <br /> 3460 NAGLEF ROAD <br /> P WWW. WORLDOILCORP.COM <br /> E <br /> D 7 RA( .: Y CA 9t'P304 TRANSPORTER EPA # CAD028277036 TRACY , CA 95304 <br /> T ( ;07Mq) Beat. 1• ; 1 (209) 82G- 1815 <br /> CUSTOMER # PURCHASE ORDER # JROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> PR 86 � MFLANItLe avela7que3 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICED TE CUSTOMER EPA # BILL of LADING/MANIFEST # <br /> 4/24/2013 CAL-0003850003) <br /> 0 7 J C� 7ff S )L) <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> 501 - 0/1 -M 1.415 GALLON Off DRUM ( R ��CONDITiONF1.)) � - - $ 52 . 00 <br /> �— <br /> G% LY SO OILY SOLK19 PER DRUM ` 85 , 00 r <br /> E PA Irrtdi� j oo murn waste plr, k up F.RATCH <br /> TOTAL <br /> CASH RECD: CHECK # Account Manager: Steve Gately <br /> WASTE DISPOSAL INFORMATION <br /> NON -RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> NON -RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATEDTSDF: --- <br /> ALTERNATE TSDF: - --- - <br /> Li <br /> DRUMS P/U: EMPTY DRUMS: FACILITY; _ BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that; <br /> ( Waste oil generator/customer MUST check ONE of the following three boxes) <br /> O M1 ) 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 compiled with the requirements of <br /> 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 I have provided about this waste is Incorrect <br /> E:J #21 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 <br /> have provided proper documentation to World 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. I agree to accept the additional charges for the disposal of this <br /> waste If the Information I have provided about this waste is Incorrect <br /> O#3) This waste is from a tank which collects waste oil from household "do•it•yourself' IDIY) and/or conditionally exempt small quantity generatorICESOG) sources. To the best of my knowledge, the only waste oil contained <br /> In my DIY/ CESOG collection tank Is soley from DIY and/or CESOG 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 /> If I am a large quantity genetatof, I certify that I have a program In place to reduce The volume and tosiclty of wdstegeurratcd to the drvlfree I have delormined to be economically prartk Able and that I have <br /> A(cited the practicable method of treatment, storage, or disposal cuirently avallable to mr vvislcbminlmtrs s the pfrumt andYuture throat to htntusn IIIe and the environment; Or, If t am a small quantity generator, I <br /> havv made a good fnNh effort to minimize my waste generation and select the best ww4L4 rtsanagemeMtl methrsA th,o b avasLlhle to me that I caa afford. <br /> This individual tlgriing 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, mryfietlland 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 Ilus Service Order. <br /> � 1 <br /> Eustomer ��-1'� <br /> i .- te <br /> Signature Date Driver Sign ture a �— <br /> •` � f <br /> Print Name Print Driver Na 1 <br />