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r ..,rs > A—Ai - s11/ M 1 IF rue . . 1 -r 11AV1 fl rIV 7/ 1 �— <br />_ <br /> FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES004-D (1?17) <br /> 559-498-0240 500 SERVICE ORDER NO. <br /> WC? <br /> FOR ACCOUMT11i CALL: <br /> 562-231-7550 W01AY r K r• ti" <br /> AF `-oa WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> 5 <br /> H <br /> M--'i 11-43A FRAC.Pli rIAC Glli 14787 EAST MANNING AVE,PARLIER CA 43648 <br /> 1.559-498 0240 <br /> P 3.•_'I►31 AUTC C.FPITER CIRCLE_ WWW,WOpLDOILCOFiP�GOM 3701 AUTO CENTER CARCLF <br /> E <br /> D <br /> q 3TOCXTOM, C'A 1,31,6212 TRANSPORTER EPA N CAD028277036 T r ' CA 9521.2 <br /> (2Mi I951-21 C,1 <br /> R;U;;E ORDER N EROUTE#] TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> E orp y I <br /> E""! <br /> TERED NEXT SERVICE DATE CUSTOMER EPA N BILLof LADING/MANIFEST Ir1r111.. <br /> PART 1t DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> 15L>ftUht S i t•; . �F'? <br /> 'f'i f!"'3 W RE,PLACEmuir it THE= 30 DRUM 0W.Y# if'•I+ !t <br /> •rt <br /> TOTAL <br /> CASH REC'D: CHECK# A-i'afurl III•srlr••�r Stilhim r3,Tfc.1 <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID{USED OIL)MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE.LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER; <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> DRUMS PIU. EMPTY DRUMS: FACILITY: 8SC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby cersity that <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Milli I have not mixed any of the waste described above with any other hamrdous waste,the total halide content is LE55 than I.WO ppm,and the waste does not contain any KBH I hate compired with the regmrernrnts of <br /> the appincable CAlrb-iii,used I management regulations to determine[his is true.I agree io accept the addit—al charges for the disposal of this waste if the lnformanon 1 have provided about This waste n quire ct <br /> =1a21 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. <br /> have pronded proper documentation to World Oil Environmental 5ervices to rebut the presumption that this waste was mixed with other hazardous waste.I agree[a acCepl the additional charges for the disposdl 011h.5 <br /> waste dttw information I have provided about this waste is incorvi <br /> [--If31This waste rs from a tank which collects waste oil hom household"do-it-yourself"DY)and/or condllionally exempt small quanuty generator ICFSQG15ources.To the toes[of my knowledge,the only wase oil con[arned <br /> IT,this <br /> oras a if the <br /> collection tank is soba bora OIY and/or waste <br /> sources.1 have not mined this waste Oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal <br /> M[itis waste if the inivrmadon I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> eecxtf 1 am a large quantity generals.I terrify that I have a Program m place to reduce the volume and toxic of wade generated to the degire I have determined 1a be eConortlli practicable and that I have <br /> Iected the prtkable method vF treatment,uore,or disposal currently available to me which minimizes the presrnt and future threat to human"le and theenvnonment.Or, <br /> have madea good faith eli To nummize my waste generation and select the best waste management method that Is available to me that I Can afford. iT am a small quantity generator, <br /> Thr 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 <br /> as packaged,marked and labeled,are ready for transportation in accordance with applicable stale and federal iegulatmns,and that Customer shall allde and be bound by the Standard Tetras and Conditions on t <br /> side of this Se-ke Order. <br /> he reverse <br /> r <br /> Customer Signature Date ` j <br /> 1 ' Drier Signature i" <br /> Date <br /> r �� — <br /> Print Name I <br /> r <br /> P1I Ives Name <br /> Scanned with CamScanner <br />