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SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES004-A <br /> SERVICE ORDER NO. <br /> 0 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> H I V-I3f,', l,;I-, ,�.I`r' 1,00 SOUTH SANTA FE,COMPTON CA 90221 T <br /> P LOS ANGELES OFFICE SAN DIEGO OFFICE <br /> P 1-800-974-4495 1-800-748-5744 <br /> E <br /> TRANSPORTER EPA#CAD028277036 <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> PART# DESCRIPTION QTY UNITPRICE QTY.p/U TOTAL <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: r-LAiLR1*UP9TAt N41i G.NRES,t9a' — EREb - - - --._ <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> e=#1)I have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,1700 ppm,and the waste does not contain any PCBs.I have complied with the requirements of <br /> the applicable California used oil management regulations to determine this is true.l agree to accept the additional charges for the disposal of this waste if the information l have provided about this waste is incorrect <br /> p#2l 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 PCB,.I <br /> 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 <br /> waste if the information I have provided about this waste is incorrect <br /> =1U)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 it contained <br /> my DIY/CESQG collection onk is soleyfrom DlY and/or CESOG sources.l have not mixed this waste oil with any other hazardous waste or waste oil from other sources Iagree to accept the additional charges for disposal <br /> of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> -V4)If I am a large quantity gul�aior,Icrrhfythat I have a fnogram In place to reducethevolume,and tocklrY of wa ste generated t4 the degice I have datprmined to he txw kally pWociible and that I have <br /> selected the practicable meCiad W heatrrent.storage,at dbposal eorrmtly avant tonewhich ml rim i—the present and future th—tea hutna,t Bteaad the envlmr-4 r;Or,if I oma small quanlRygenerator I <br /> 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. <br /> This individual signing n 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 <br /> 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 <br /> side of this Service Order. 5 <br /> Customer Signature 7 Date Driv&Sigftagt& Date <br /> Print Name Print Drivers Name <br />