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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 /> 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> H <br /> 1 1-559-498-0240 <br /> F <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> 0 TRANSPORTER EPA III CAD028277036 <br /> 7 <br /> O <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA It BILL or LADING/MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK# _ <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMfXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing Chalons,I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Oa D I have nos hued any of me waste dncnbed above with any other haaxdous waste.the total halide content Is LESS than I,"ppm,and the in.does rot coblan Any PCas.I bare complied with the requhements al <br /> the npplkade Callbmia used dl management regulations to deiermine Mb is vee l Agree m accept the additional charges for the disposal of this waste if the asformatlon I hale providetl about this were Is Incorrect <br /> Oat hart not eland any Wthe antra dexribed above wdh any other hawrdom waste the total name content s CHEATER Man LOoll ppm,and the waste tlees not corneln airy PCBsI <br /> bee prwfded proper documentation to world Oil Enstonmente services to rebut the commotion that thin were was mlxM with oMw havocous waste I Agree to accept the addtbnal cMrges dor the dspwaf W this <br /> were it the inlgmatlm I have punkled about this waste h Incorrect <br /> O131Thls waste Is from Atank which Calle,is it.a1 from househod'do a yourself'(W)aroior conditionally exempt small usable y"usalm ICESMI maces.To the best of my knowledge.me only waste off contained <br /> in my mi Moo collection tank Is sole,from DIY andlor CESOG swrces.I have not mind this waste of wIM any other hatadous.,in or wap.dl from miner sources.I ogee to accept the additional charges for disposal <br /> of this wap.IF the mfomadon I hree provided about this waste is i,scorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> I=1NIIf I Am A large quantity generecr,Icurdy that i have a program in dace tu,adooe the volume and toalcity Of it.genie"to the degree IWve detwmmen to be en minimally practuable and that I hnvx <br /> selected the practicable method oftreatment,storage,or disposal curtly awllable to ma,which bromides the present And future those to human life and the soombusm[C it l am A smell taim,generator,I <br /> have made a good faith effort to memfae my waste generation and select the best waste management melhod the is available to me shat 1 can aRmd <br /> This Ibrilvldml dymus,in the space set fond below on behalf of Customs represents and werann that he/she has the authority b,hind Customer,that the forgoing descdpuons of waste and materWs are else and accurate <br /> .so ,rorked and bholaa,am readyfn.mmyw,rtmnn In acrMdame wish appurahM pA',and federal requWtrons,and that customer shail ands,a,d b,bound by the Standard Terms and Conditions on the Teres <br /> side W this 5eryke Orde,. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />