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FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> 559-498-0240 O SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL. <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> i 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> H <br /> 1 1-559-498-0240 <br /> P <br /> Is WWW.WORLDOILCORP..COM <br /> E <br /> 0 TRANSPORTER EPA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA N BILL or LADING/MANIFEST N <br /> PART DESCRIPTION QTY UNITPRICE QTYP/U TOTAL <br /> i, <br /> TOTAL <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: it_ <br /> ALTERNATE TSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By sigmrg below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Da 1?1 have not urged any of the waste dexrlbed above went any other hazardous waste,the total hall"content Is LESS Man I.M ppm.and the mist,does not contain any PCNs.I hate complied with the regWremenb a <br /> the appltaWe Celllornia usetl oil management regulatlonr to determine this is true.I agree to Assam the addntonal charges for the cNiMial of this waste If the Inforrrratbn I ham provided about this waste is Incorrect <br /> Oa11 have notmlaed any of the waste disinherit arrow,wdh any term hams us wane,the total hdde comers Is GIRWER than 1.001 Mot,AM!the more does not contain any Kill.I <br /> ism ptoseded proper dxumentahon to yymid bel Environmental Sinister w rebut the p.eeumpuo,that tMs wrote wee meed with ielxe Isarardws waste I agree to a rshpl the additional charges In Me disposal of this <br /> waste N the Istfpmetbn I ham provdad Abrar this wave Is Incorrect <br /> 171 F3)This waste Is from a tank whkh cdiech waste oil ham],.rancid'do it seneseN'IDIYI andror cdMltionally ercmpt rmdl gnanmy 9wwrator ICESOGI Lancer To the hest of on,knowledge,the of,waste oil contained <br /> In eny OlY/CESM mllMlm frisk Is sdey from OlYand/m tr <br /> CESQG sanI..I ham ot mmd iter waste oil whl any oNus <br /> ther hitaowaste oe d <br /> r wastl from often sounces.I agree to to Accept the aM.tlwral dwges for dispmal <br /> of 11-11 were,If she into.mason I lave prowded about this waste is Incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> OaAI11l am a Iangequamlly yeneratgr.l[want Mat I ham a program In plAce td reduce the volume arts tonlory otwaste gwtemted tothe degree I have dnwnnrred to he economically prwthahreand Mal I have <br /> selected Meprecdoble methodNtreatment,stmege,wdisposal currerrdyavadable to ow.hch monlrMres the eastern AMhnae threat to denied life AM the enebonmen,Or,if ns <br /> d, <br /> hive made a gts ef <br /> shared felfort M minimize my wade gormth n And redact the beer waste mwugement method that Is available to me that 1 can Af ad. <br /> This Individual seyong in the space set fort below on behalf of Customer represents ami]warrants that herMe has the authority M hind Cte nmw.Mat Me fohtdr dee nfnlci of waste and mess en.k aro hue AM Accurate <br /> as yackagM,marbd AM labeled,are ready fa transportation marc nfanowithappkaab4 state AM federal regublky ,and her Cmtnmer Shad adds,and he louts by Me Standard Termsend Condnons on the terns¢ <br /> Me of thio Sen d e Order, <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />