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3 <br /> FOR SERVICE CALL: SERVICE ORDER <br /> _. ... .. - _..... <br /> PARLIER AS1gURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOE5004-D 1/17) <br /> 559-498-0240 WD SERVICE ORDER NQ,.. ,. <br /> FOR ACCOUNTING CALL•WODW <br /> N23+88 ' <br /> 562-231-1550 `' <br /> AF 400 <br /> ENVIRONMENTAL SERVICE& <br /> H T NIA <br /> 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> P :gip E ( '� `# -559-498-0240 70ra0 E LWIN AVE <br /> r <br /> aWWW.WORLDOILCORP.COM <br /> LA�R4p�CA <br /> T CA S� „�.�. 0 TRANSPORTER EPA##CAD028277036 �"a THMP' 0 <br /> 0 868-4110' I s <br /> t <br /> PURCHASE iDEI.# .. .._ ROUTE TRUCK# CONTACT NANMI �'•-70 DE T��(EI��"` -. IIDES;'�W� <br /> t <br /> DAIls B l�lJ hl�`„•;`.._._...._r.D.TE_ NTERV-- "IVEXY Si RV(CE DA _~ CU 70MER EPA's :BE ;o IADI[�GIMANtFESf _ <br /> :'PA : r..... DESCRIPno ' . PRIG:OF U 0l L COIL:AND GASOLINE FILTERS 4 , X55.00 2ZO.CO I <br /> IT <br /> rAS <br /> CK <br /> WASTE DISPOSAL INFORMATION' <br /> r' <br /> :(us�o:o�i/Mix b:alLs� STATE CODE 221jhtithij ' <br /> N f OIL)IMATE <br /> CM <br /> 2x3 STATE cooE t <br /> :� 114X'= IVH.�VUW3s ,. <br /> .... <br /> DRUMS:F'J f' EMPTY DRUMS; FACILITY BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE•:APIROP. 0..5.1130 ) <br /> By signing below I hereby certify that ” <br /> (Waste oil generator/customer MUST check ONE of't'he Wowing three boxes) <br /> I=M 1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the wAiMo does not contain anyPCBs.l have compiled with the requirements of <br /> the applicable California used og management iegt ntlons to determine this is true.I agree to accept the additional charges for the disposal of"waste If the Information i have provided about this waste Is incorrect <br /> ., <br /> C-3021 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,o0b ppm,and the waste does not contain any PCBs.I <br /> ha+►q pt ded`pro�ie{efocelmtxhtatian to t Etlttltbttmelttal ieNlceito retiutthe prttsysnpll n that.tE4 waste was mixed with other haze •%ste.l agree to accept the additional charges for the disposal of this <br /> i�ustat�ti?!�rit�l(rro�i�i�avepnodtd al>vyt thkvrast�is 2c�totteti •" <br /> /3?Thhwut4k�ioni3#e>fyorrh-)fieoit�cc;iiriisteoll. 5titiltehoid?t!a }antliarionclkioriii[lyexetrip ... .theoyocodbyosfeadsfw!)gil:bnwv� t <br /> fidcNdfany $001 t.1agreeWic; sfor&tmpHIG:53Gtg <br /> of:thhwmitibeinfwalt!iLvve vddedabot.* wekcnet l <br /> (All generators/customers MUST read the following text and&ck the associated box.) <br /> p64)If I am a large•gtrathtt .Qerietatar,I certify tWi have a program In place toreduce the'voiurne and toigity of waste generated to the degree I have determined to be economically practicable and that I have' <br /> selected the practic:tbfo-metftpd,of treatment,i"o.or disposal currently avillaiila tome which minImIii►ahe present and future threat to human life and the environtnenC Or,if 1 ant a small quantlty generator,t <br /> have made a goodfalth effort tovminlmite my waste generation and select the best waste management method that is available tome that I can afford. <br /> Tlds kXg.Wr3ilal si¢t1if191n Etit'tp#e sikt fo*h 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 /> asQi[ke,(}tr 'etsltlbltj s iabekt!°are toddy for transportation In accordance with applicable state and federal regulations.and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br /> stde.ofthit lkdet <br /> Cust. r Signature D Driver Signature Date <br /> _.� <br /> Print Nam Print Drivers Narrfe <br />