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77­07­77� -77 7--­ <br /> OR$ERViCE CALL: SERVICE ORDER ; <br /> ASBURY:EIVVIFtp1VMi=MTALSERVIGES, DBA "FORMNO.WOES004-0 (1/17) <br /> PARUER r + 0 . <br /> 559-A0240: SERVICE ORDER NO. • . <br /> 1t 0 r <br /> rOR ACCOUNTING CALL. <br /> 562- 31=1550 WOf�I�' N25' 1. <br /> L iL ' <br /> ENVIRONMENTAL SERVICESt., <br /> H94287 EAST'MANNING•AVE,PARLIER CA 93.648" �IIE T:t ESOUR E M MI'-SIRE <br /> !�l( E1 t:1NE074I 1-559-498-0240 <br /> P 726' 'FIAMMF_R LANE 6175 MAIN REET+;5UITE 42t? <br /> p W W W.W0RLD0IbGORRCOM <br /> E <br /> % TOOI4TQN,OA 95210 TRANSPORTER EPA#CAD02$277Q36 FRISCO,TX,7303+4 <br /> ° .( (g)gb9-24( (072)'4040004 <br /> CUSTOMER# :PURCHASE ORDER#" ROUTE# : TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> FIRE327 PERO. .c>Z PCHEPULED-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST#. <br /> 1/22)2016_ 1JIW2018 'r <br /> ,PART DESCRIPTION QTY UNITPRiCE' QTY�P/U. TOTAL <br /> OFNC. NOIV .OIVOIIifNf OIL.FILTERS , <br /> . , 41, <br /> : <br /> BATON# <br /> r� ! TQTAL . <br /> :REC IJ CHECK.# <br /> Account AA�n <br /> CASHa .'Steve tea <br /> WASTE DISPOSALiNFOR MATI <br /> OPd <br /> NON RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE. <br /> OTHER <br /> DESIGNATED T N <br /> YUWA YES <br /> ALTERNATE TSDF: LLt2730 E 13TH ' <br /> 028-864-2803 <br /> DRUMS P/U DRUMS FACILITY BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE.CHECKTHE APPROPRIATE BOX) <br /> By sloping below I hereby certify that <br /> t (Waste oil generator/customer MUST Check ONE of the following three boxes)' <br /> OR7)I liav®noYmtiret)any'of the waste described abo�with any other hazardous waste,tKe total halide content is LESS than'i pW ppm,and the waste does not contain arty PCBs.I have complied with the'rcqulrements of <br /> e.l agree to accept the additional charges for the disposal of this waste if the Information i have provided.about this waste is krcarect. <br /> the applicable Californiala used ori management regulations to determine this h tru <br /> Ql;�i haVe1hot mixed any of the waste described above with any other hazardous waste,the total halide-content is GREATER than tAw ppm,and the waste does not contain any PCBs.I <br /> have pirnvided proper dgNmentatipn to World Oil Environmental Services tomb t theptesumption that this,waste was mixed with other hazardous waste[.agree to accept the additional charges Por the.disposal of this <br /> wastoififi$inforrpatbn.iF�veRtovidedaboutthiswasie,l�rfncorrect,. ,; - <br /> A3)TIt)S WaEta is fro Ili nk which;collects waste ou from hjousehoki 1lo-it yourself°(DIY)and/or condidonally exempt smaR;quantity generator(C€SQG)sources:To the best of my knowiedge,the only waste oil contained .: <br /> n my.W*%dspd to)lection tank is soley from W ahwor dkiGi sources.itiave not robbed thls waste oil with any other hazarCous waste or waste oil from other sources.I agree to accept th`e additional charges for disposal i <br /> of this Waite if the information 16ave.provided about this waste Wncorrect . <br /> i <br /> (All generators/customers MUST read the following text and check the associated boz) 1 <br /> �)If Iain a large quantity generator,I cert*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 <br /> selected the practicable method oftreitment,storage,or disposal currently available to me which miriimiaes the present and future threat to'human lue and the environment;or, m a'if 1 asmall quantity geernator I ; <br /> have madea good faith effo"ItQ nilnbmize my wast8 generation and select the best waste management methoil,that is available to me that I can afford: i I <br /> This individual signing in the space set forth below onbehalf of Customer represents and warrants that he/she has the authority to bird Customer,that the forgoing descriptions of waste and materials are true and accurate j <br /> as packaged,.rgarked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and thatCustomer shall abide and be bound"a Standard Terms and Conditions on the reverse ,1 <br /> side of this S ,44 1 <br /> ce Order. <br /> f ' <br /> `Customer Si nature ; ate Driver Signature Date <br /> I <br /> ` ,Print me Print Drivers Name <br />