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SERVICE CALL% *a.nv 1%wllr vnva_n P'AF?LIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-D (1/17) 559 M4 0240 SERVICE ORDER N0, FOR ACCOUN77NG CALL, 5624314550 WC AY ' AF 200 WORLD OIL ENVIRONMENTAL SERVICESIM 5 14287 EAST MANNING AVE, PARLIER CA 93648 M NIATAGA BUICK POWIAC GMG 1-559498-0240 P 43;w31 AUTO C F11TE:R CIRCLF www.woRLDOILcoRPcoM 3201 AUTO CENTER CIRCLE E TRANSPORTER EPA # CAD028277036 •, T 'S`i•t=. XT014 (%A 95212 .sTOC KTON, CA 9521#2f O (20p) 951 - 02 190 (2i E i 951 a2100 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDERTAKEN BY HALIDES MAT020 HAZ WASITE ONLY X14,•36 Zd JOSE avelamuez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # 411CV2018 CAD98M4"2 PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL OFOR CrIL FILTER DRUM RElJf ACCFMEt4T • NO CHARGIE � $000 l OF USED MLJAL CIL AMG GASCLINE FILTERS $Sa.Utl Jotof, FLO .FS 09v94&NJ46 PATM# �;f ifec*I TOTAL CASH RECD: CHECK #. A(.'fifkint Mdrmw Steve Odt WASTE DISPOSAL INFORMATION NOWRCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NOWRCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATEDTSDF: ALTERNATETSDF c', "'t DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) By signing baba I hereby cMiy that: (Waste oil generatorlcustomerMU5T check ONE of the following three boxes) Ms I) 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 contain any PC85,1 have complied 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 i have provided about this waste is Incorrect O121 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 disposal of this waste If the Information i have provided about this waste Is Incorrect p831 This waste is from a tank which collects waste oil from household 'do•It•yourself' (DIY) and/es conditionally exempt small quantity generates (CESOG) sources.To the best of my knowledge, the only waste oil contained in my DIV/ CESQG collection tank Is coley from DIY and/or CFSOG sources. i have not mixed this waste oil with any other hazardous waste of waste oil from other sources.) agree to accept the additional charges for disposal of this waste If the information 1 have provMed about this waste is Incorrect (AI) generators/ customers MUST read the following text and check the associated box.) a41 If i am a large quantity generator, l certify that 1 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 1 have 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 1 am a small quantity generato4 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 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, 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 side of this Service Order. IL Date Print Name Driver Stanature , Date