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r ^ • FOR SERVICE CALL: ( SERVICE ORDER PARLIER ASI3ORY ENVIROIVM L SERVICES, DSA FORM NO.WOES004-D (1/17) 559-49$-0240 W(} @ } SERVICE ORDER NO. FOR ACCOUNTING CALL: WODIY 718 562-231-1550 NZ411 AE 165 WORLD OIL ENVIRONMENTAL SERVICES,. H FIRESTONE#02874614287 EAST MANNING AVE,PARLIER CA 93648 RESOI IRC MCMC IRE v 720 E. HAMMER,I LANE 1-559-498-0240 6175 MAIN STREET, SUITE 420 P W W W.WORLDOILCORP.COM E 0 43TOCKTON, CA 95210 TRANSPORTER EPA#CAD028277036 FRISCO,TX 73034 � T (209)951-2403 (972)464.00014 CUSTOMER# PURCHASE ORDER# f18:6 OUTE# ;TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES F.8627 SCHEDULED IKaoheco 2. DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 8/3V2017 CAL.0003211 b 12791 PW j J PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL -C/TM GALLON G/T METAL DRUM 1 9 BRAKE BRAKE FLUID REFS DRUM 1 BATCH 0 Cro is S Bets: TOTAL CASH RECD: CHECK# Account Manager Steve Gately WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OiUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: DRUMS P/U: `tEMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) Milt)I have not mixed any of the waste described above with arty other hazardous waste,the total halide content is LESS than 1A00 ppm,and the waste does not contain any PC8s.I have complied with the requirements of ,the applicable California used oil management 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 incorrect - M#21 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.i have 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 waste If the information I have provided about this waste is Incorrect 177193)This waste is from a tank which collects waste o8 from household"do-it-yourself(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESQG collection tank is Soley from MY and/or CESOG sources.t have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of 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.) M#4)if I am a large quantity generator,I certify that i have a program In place to reduce the volume and toxicHy of waste generated to the degree i have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that Is available to me that I can afford. This 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 as packaged,marked and labeled,are ready 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 , side of this Service Order. ff ,f' 4. .' pK?/ill—lLZ— n2 li L/—L Crrrer Signature Date Driver09 natul Date Print Name Print Drivers Name