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_.......,.....�....,�..� ......�.., .,,.., FUHM NO.WULSU024) (1/17)
<br /> FOR SERVICE CALL: �•
<br /> PARLIERSERVICE (ORDER
<br /> 559-498-0240 P
<br /> FOR ACCOUNTING CALL:
<br /> 562-231-1550 WOF&D OIL No. N 9082120®82120
<br /> ENVIRONMENTAL SERVICES,.,
<br /> 14287 EAST MANNING AVE ❑ PARLIER, CALIFORNIA 93648 ❑ (559)498-0240
<br /> EPA#CAD028277036
<br /> DATE l �] a�
<br /> r .�. CUSTOMER NUMBER
<br /> z � ;�
<br /> CUSTOMER ►'� � � �� � AMOUNT
<br /> PHONE h�' l �1' 1 CONTACT CHECK NUMBER_
<br /> CUSTOMER EPA# G �u V �,O 7 � _ P.O.NUMBER
<br /> JOB SITE ADDRESS -? O CtI"C c-) CASH RECEIVED
<br /> L1 C IR" (AMOUNT)COMMODITY
<br /> CROSS-STREETS HALIDES P.P.M.
<br /> NOTES:
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221
<br /> *NO PLACARDS REQUIRED*
<br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE
<br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE
<br /> ❑ OTHER Y_ DRUMS DRU'M7 SIZE
<br /> MANIFEST NO.- 6 1 L14 1 e, — NO.OF GALLONS
<br /> DRIVER_ l��C If _ TRUCK NO.&RT.
<br /> 11r-41-
<br /> ❑ USED OIL AND GASOLINE FILTERS _
<br /> ❑ BIG SKY ENTERPRISES, 401 West Channel Rd.,Benicia,CA 94510 CAL 000301639 1-510-541-2128 f
<br /> ❑ GLOBAL MATERIAL MANAGEMENT, 1640 N.Broadway Ave.,Stockton,CA 95205 CAL 000417316 1-818-7701 2577
<br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 SOU 0 9 2011 ;
<br /> ❑ YUMA YES LLC, 2730 E.13th Street,Yuma,AZ 85365 AZR000515924 1-928-643-8938
<br /> ❑ ALTERNATE FACILITY
<br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES-2549 Scat Avenue-Chico,CA 95928-CAL=27844
<br /> ❑ ASBURY ENVIRONMENTAL SERVICES•CHICO H,LLC■1618 W.5th St.,Chico,CA 95928■CAD98DB941D3■(800)733-9043
<br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA*200 Dinsmore Dr.,Fortuna,CA 95540-CAL930256136-(800)733-9043
<br /> ❑ BAKERSFIELD TRANSFER INC. ■1520 E.Brundage Ln.-Sakersflold,CA 93307•CAI-000282598•(661)377-0308
<br /> ❑ DI DIXON*7 300 Chevron Way-D[Yon,CA 95620*CAT080012602*(707)693-6008
<br /> ❑ DEMENNO1KERDOON-2000 N,Alameda Stnaek*Compton,CA 900P*CAT080013352•(310)537-7100
<br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722■CAD9B2446882-(510)795-4400
<br /> ❑ RAMOS ENVIRONMENTAL-1515 S.River Road■W.Sacramento,CA 95691 •CAD044003555-(915)371-574T
<br /> WORLD OIL-SAN JO i ,LLC•14287-E.Mc�nnIng.Ave.•P lier,CA 93048-CALO 010 51 ,(55 9)498-024. r
<br /> ALTERNATE FAC[LIT C �r
<br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to 21TUP1411 rT��bcwr�n a4KI /are�1r' `ass tlrs�oFF> �g d, marked
<br /> RECYCLED C OUR SISTER COMPANY D WESTERN UNITED ST THE and labeled,and are in proper eond[Ilon f r i nsporla[Eon,according In the appllca a regulations of
<br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Depart t of ransportanon.
<br /> 11 HERBY CERTIFY THAT I HAVE NOT MIXED THIS WAST E WITH ANY _ J_
<br /> OTHEn WASTE,THAT THE TOTAL HALIDES ARE LESS THA_N 1000 P.P.M.; X
<br /> AND THATTHE WA5TE DOES NOT CONTAIN ANY PGM'S:. GUsT4ME SI NRTufiE DATE
<br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL
<br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR I � r
<br /> CONTAINS ANY PC,B'S. PRIh11 M
<br />
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