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FOR SERVICE CALL: SERVICE ORDER PARI_IER ASBURY ENVIRONMENTAL SERVICES, DBA FORNI NO. WOES004-D (1/17) 559-498-0240 FOR ACCOUNTING CALL: '*e•\s SERVICE ORDER NO. 562-231-1550 WORLD OIL S ENVIRONMENTAL SERVICES, " 14287 EAST MANNING AVE, PARUER CA 93648 P 1-559-498 0240 P ""WW.WORLDOILCORP.COM e T TRANSPORTER EPA # CAD028277036 O CUSTOMER PURCHASE ORDER t ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 9 BILL of LADINGWANTEST t! r PART r DESCRIPTION QTY UNIT PRICE QTY P,/U TOTAL r- TOTAL CASH .REC'D: CHECK It WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: 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) ,Ok 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 Pus. I 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 p#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 have provided proper documentation to Word Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. l agree to accept the additional charges for the disposal of this waste If the information I have provided about this waste Is incorrect p03)This waste is from a tank which collects waste oil from household'do•it-yourself•IOIY) 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 DIY anti/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 of this waste if the Information I have provided about this waste is Incorrect (All generators/ customers MUST read the following text and check the associated box.) �4) If I aro a large quantity generator, I certify that[ have a program in plare to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that 1 have elected the practicable method of treatment, storage, or disposal currently available tome which minimizes the present and future threat to human life and the envlronment:Or, If I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available tome 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 b4ound by the Standard Terms and Conditions on the reverse side of this Servfua Otder, i i Customer Signature Date Driver Signature! _ �/ Date / _ - 1 Print Name �� /�+ Print Driypsme .