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FOR SERVICE CALL- SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WDES004-D (1117) <br /> 559-498-02417 O SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL. <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> s 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> P <br /> p WWW.WORLDOILCORP.COM <br /> E <br /> D TRANSPORTER EPA M CAD028277036 <br /> T <br /> e <br /> CUSTOMER k PURCHASE ORDER# ROUTE a TRUCK tr CONTACT NAME ORDERTAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA It BILL of LADING/MANIFESTf <br /> PART a DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK N___ <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIVMIXEDOILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE__ <br /> OTHER: — <br /> DESIGNATED TSDF:. <br /> ALTERNATETSDF: <br /> DRUMS Pill EMPTY DRUMS: FACILITY: BSC____._ <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By"Ing below 1 hereby,comfy that, <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Dal l I new slot mixed any M the wase described above w11h any olhw nanraops waste,me total halNe content Is LESS Man 1.000 ppm,and the waste don rid rdnlam any PCBv 1 have mmpiretl xrM the regdremunn M <br /> the applkabe Celilorma used di toanagement reguartiuns to determine his is pue.1 agree m accept the addlHmel clsargn fm the deposal M this waste dHrc Inlmmsllon 1 M1em provked about this waste 1s Iricorren <br /> O121 have not mixed any M the waste dnoibed above with any other hazardous waste Metoal nalde<antent rs Gli Anil than 1,000 ppm,and the waste does not contain any lido I <br /> have pmvrded proper docummretbn to World pt FnvironmmW Snwcen Io rlbpl the presumptbn IMI INs wane was mined wth other haaallouswart.l agree tp areept the addlronal charyn br the dspnal M IMs <br /> waste N dor InlormatNn 1 nem powded about Mrs wane n MwrrM <br /> O431 This wave is from a aokwhkh collects"stem from household VoipyvurseH-IIMYI andice conditionally eaempt small quantity generator ICESQGI swnes.To the bank W my knpNedge.the Duly waste oil contained <br /> m my Dv/CnOG mllenion tank is soney from DIY andfor CESOG nwrcn.I ham trot miaed MIs waste all with airy other M1azardaus were or wase ill from wher sources.I ague to accept the Additional charges for dbposal <br /> M this waste If qn,Information I have prowdM about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> [=lw it I am a large quantity generator.I randy that l have a pogrom in piece to reduce the wdume and toucity M wave gnw-re1rJ rate dryee t l aw:demmtmd to no nonommallypmaluble and May I have <br /> selected me practicable method M treatment st«age,or dspnsal currmdy available to me which minimim the pesmt and future thea)to human life and the eperoomenb or.it t am a small quantity generator,I <br /> ham made a good faits aHlgrt to mMMfe my wave,merahon and seed the bent waste nunagen ma m orhod and is available to me that 1 can afford. <br /> TMs tnd Adual sigmrg in the space ort forth below on behalf M Customer represents and warrants that hI has the Authority to Mmr Customer.Hat the forgdng descnptom of wave and materials me true and accurate <br /> as awk twi narked and libeled,are ready for hanaponauon In•crprn-re.,in appllrabie Rale arts Inderal"Marnim,and that Customer Shall abide and be bound by the Summand Terms and Conditions on the reverse <br /> sore o!mis Service order. <br /> Customer Signature Date Driver Signature Date <br /> Print Nanta — — - - —_ - <br /> Print Drivers Name <br />