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VOR SERVICE CALL: SERVICE ORDER PARLtER ASBURY ENVIRONMENTAL SERVICES, DBA FORM No.WOES004-D (1/17) 559-498-0240 WO 200 e? SERVICE ORDER NO. t FOR,ACCOUNTING CALL: iflfODl Yr N2455328 i 582-23.1-1550 AF 105 WORLD OIL ENVIRONMENTAL SERVICESr., H FIRESTONE#0:28745 14287 EAST MANNING AVE PARLIER CA 43648 QUEST RESOURCE MGMT FIRE ) i 1-559-498-0240 P 720 E.,HAMMER LANE . 5175 MAIN STREET,SUITE'420 s P WWW. WORLDOILCORP.COM T STOCKTON, CA 95210 TRANSPORTER EPA#CAD028277036 FRISCO,TX 73034 o (209) 951-2403 (972)484-0004 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCN CONTACT NAME ORDER TAKEN BY HALIDES I FIR627 ER- SCHEDUL.ED4 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 10/12/2017 10/9/2017 CAL.000366211 I i PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE 1 OF'NC NON CONFORMING OIL FILTERS � 1 BAT(hi <' Cr TOTAL s CASH RECD: CHECK# Amount Ma na :Steve tefy ' 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: NO&RCRA HAZAEiDWS WASTE 801 in(Ell TERS QCWAIN114G Oil)i STATE QWE 223 DESIGNATED TSDF: ALTERNATETSDF: a DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) • t By signing below I hereby certify that: i t (Waste oil generator/customer MUST check ONE of the following three boxes) E-1101)[have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,006 ppm,and the waste does not contain any PCBs.I have compiled with the requirements of the applicable California used oil management regulations to determinethls Is true.I agree to accept the additional charges for the disposal of this waste if the information t have provided about this waste is incorrect M#2 I have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than i3Oo0 ppm and the waste does not contain any PCBs.I have provided proper documentation to weld 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 j waste if the information,I have provided about this waste is incorrect - p1113)This waste is from a tank which collects waste oil 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 1 in my Dry/CESQG collection.tank is soley from DIY and/or CESOG sources.I 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 O f s 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.) If I am a large quantity generator,I certify that I 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 I have the practicable method of treatment,storage,or disposal currently available to which minimizes the present and future threat to human life and the environment;Or,If t am a small quantity generator,I 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. ndividual 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 i Customer Signature Date DrIveL*natqer Y Date Drivers Nam Print Name Print