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)R SERVICE CALL: SERVICE ORDER ' IRLIER ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES004-D (1/17) ;9-498-0240 wo 1000 ORDER NO. WOW )R ACCOUAMNG CALL: WODIY _N24a95'17 ;2-231-1550 AF 400 ��/' :F f:� .:.rv..w".' ENVIRONMENTAL SERVICES TEC OF CALIFORNIA 14287EAST MANNING AVE,PARUER CA 93648 1-ss9-496-0240' 2050 E LOUISE AVE J: 2050 E LOUISE AVE i wwwwoRLDOILCo.RPC;OM- ► LATHROP,CA 95330 TRANSPORTER EPA KAD028277096: L,ATHROP,CA 95330 (209)'858-41-10 (209)$584110 s �CiSrOMER '`'". PURCFfAS 'OR. :RS'I :#t _TR...' :_. . CONTACT NAME - ORDERTAKEN..BY . _..HALIDES Y , TEC605. 86 7 BARRY adavls a 1 l - t _ _. TATE REQUIRED DATE ENTERED: : ; .:NEXT.SERVI TE'.. .. '..-,:, IISYDAN F.PA _ _. .. _.81LLof.LAD1N IN1ANIF .�W._..:._:_... 7/24/2017 CALC00416480 • is y ' ., _ .—.—..sk....YY:'...n ..... -t.'... ..�....._ :..wJJ. ._rte_--.._•a- PART# DES.CRIP:TI0_N u TPRrCE' r` Tyr PIU` TOTAL: .. UNI • t s OFDR OIL FILTER DRUM7REPLACEMENT' NO CHARGE. j $0.00 3 $QY.► Q OF USED METAL'oIL P�ND:GASOUI�E:.!"ILTER$ $55.00 , 3 ._ .. " 4e. f CELL-06 42-6312.ASAP BATCH 0 Orco:. Str6ets:': ; __. ._ .... TOTA! :ASH RECD;- , CHECK#i` WASTE DISPOSAL INFORMATION j f NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE 07NER: , ATEM >`A1_TERNA7E130Fs �-. • -- EMPTY DRUMS: - FACIt:fkY )RUMS P1lJ:- . GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) ` y signing below l hereby certify that: �7 Y.- (Waste oiI generator/customer MUST check ONE of the following three bodes) It 1)1 have not mixed any of the waste described above with any other hazardous waste,the total hailde.content Is LESS than 1,000 ppm,and the waste does not contain any PC8s.1 have compiled with the requlremenis•of )e applicable California used oil managetnent regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste Is Inconect IM21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,000 ppri%and the waste does not contain any PCBs.I t ave 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 addttlbnal charges for the d3posal of this caste If the infomtatlon i have provided about this waste is Incorrect i'. 93)This waste is from a tank which collects waste all from household'do-11-yourself'(01Y)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knoviledge,the only waste oil contained t my VIY/CESQG collection tank Is Soley from DIY and/or CESQG sources.I have not mixed thlswaste all with any other hazardous waste or waste oil from other sources.t agree to accept the additional charges for disposal f this waste if the Information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text and check the associated box.) 64)If I am a large quantity generator.I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that 1 have :leered the practicable method of treatment,storage,or disposal currently avallable tome which mtnimlzes the present and future threat to human rite and the environment:or,If I am a small quantity generator,l ave made a good faith effort to minlmlze my waste generation and•select the best waste management method that Is available tome that 1 can afford. his Individual. in the spa t(orth .-on-behalf of Customer represents and warrants that he/she has the authority to bind Customer,the oing descriptions of waste and materials are true and accurate 1 pickr>fle�;>tiarkitd "bo tea ottroonIn,accordancewith applicable state and federal regulations,and that Customecsh=llatth ;, Kd,I'/sound by the Standard Terms and Conditlons on the reverse deorthlsS 4. 1A 01— ,Uqo er..ign tore Date Drly g' re Date rint Name Drivers Name