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)R SERVICE CALJL: SERVICE ORDER <br /> XON OFFICE ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES004-B <br /> 800-7-ASBURY wo 1000 <br /> %RLIER WOMY <br /> !N2319842 <br /> i9-498-0240 <br /> A <br /> Lilco F 400 <br /> )0-733-9043 WO. <br /> -mo OM <br /> ENVIRONMENTAL SERVICES <br /> TEC OF CALIFORNIA 1300 SOUTH SANTA FE,COMPTON CA 90221 <br /> 2=E L.OULCA AVELOS ANGELES OFFICE 2=E LOUISE AVE* <br /> 1-800-974-4495 <br /> LATHROP,CA 9WW <br /> TRANSPORTER EPA#CAD028277036 LATHROP,CA 9= <br /> r20Aj8W41101 (209)OSS41 10: <br /> 'MAER4I �Pjf(tRA7 CT <br /> NA E <br /> QRDMIA99 0V <br /> 6.m; <br /> squintima <br /> -CUSTOMER EPAV <br /> f <br /> N �S <br /> TATEREQUiRED -DIW6 tAPIN5 jfEST,!. <br /> is 2MOM11 CALM164M <br /> QN 78 <br /> PART PF -MoNt IT <br /> WAR—O"" <br /> OFM 1 FILTEKWUMW!-� No' <br /> OF USED METAL.&AND GA89LINE.RLTEERS 2-- $55.00 <br /> jlot <br /> J <br /> CELL 12 <br /> -2 OF 2 METAL BATCH# <br /> 200�0 <br /> .... ......... <br /> . <br /> ........... ............ <br /> .............. ... <br /> :ASH <br /> QiKK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE LIQUID(USED 01UMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS). STATE CODE- <br /> OTHER: "NOt"Mk- l WASM,4101.10(FILTNS.*1*bA'NW <br /> _OIL)STATE CODE 223. <br /> DESiGNA7W'tDr,-,--,,.714k-"i�W"4 <br /> ALTERNATETSDF: <br /> MHSMM 0.$A <br /> &Use <br /> )RUMS EMPTY DRUMS.-,--�. FACILITY,,_- BSC <br /> NO F, ME <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> FEB 2 21 2017 <br /> .y signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following threeb�*­­ <br /> c 4014i�y.d <br /> IN11)I have not mixed any of the waste dexrlbedabove wlthany other hazardous waste,the total hallcW-cententh LESS than 1,000poftgd;� i 0 <br /> he applicable California used oil management regulations to datefirrilnethis is true,lagree to accept"additional charges for the.osjw4w 0* 10�ie 1i <br /> —,1114 -11oh"hilinioprovided about this waste Isintoned <br /> 1021 have not mixed any of the waste described above with any other hazardous waste,the total hatIde content Is GREATER than 1,000 ppm,and the waste does not contain any FC113.I <br /> tave provided proper documentation to world Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this <br /> iaste If the Information I have provided about this waste Is Incorrect <br /> 1#3)'Ibls waste Is from a tank which co(lects waste on from household'do-It-yoursell"(011f)and/or condltfona4 exempt small quantity generator iasaw sources.To the best of my knowledgp,the only waste oil contained <br /> %my DIY/CESOG collection tank Is coley from 01Y and/or CE5QG sources.I have not mixed this waste oil with any other hazardous waste or waste oil room other sources.I agree to accept the additional charges for disposal <br /> I this waste If the Information I have provided about this waste Is Incorrect <br /> (Al I generators/customers MUST read the following text and check the associated box.) <br /> 1 14)it I arri'a large genna (I -iegbee and to)dciv of vialtegei�to the degree I have4ettirmined to k�e'*ciom- M660 4ble,W that V*16m- <br /> tt*!l yeaptd9f"-h)-pW&�P t <br /> 2ecteitl Ibfp1jCIIc�bIe method of w djs 000 Oio*avw4bk to-mewlikhminimizes,theprese4and.f.uture threat to human llk.&M the errykc�t.Or,if I bm i UrA quam#.y gelpoatt?'.I <br /> ave 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. <br /> his Individual signing In the space set forth below on behalf of Customer represents and wanants that he/she has the authority to bind Customer;ftt"forgoino.de%capu iso and materials are true and accurate <br /> s packaged,marked and labeled,are roady for transportation in accordance with applicable state and federal regulations,and that Customer shall abide arta be boimdb Terms and Conditions on the reverse <br /> de of this Seivice'd <br /> 0 <br /> .. 12 <br /> us s <br /> .0ome AWI`4 Date DriverSi' mafore <br /> Namesdr <br /> rant Printnrivorr Namp <br />