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I' FOR SERVICE CALL: SERVICE ORDER PARL1E•R ASBURY ENVIRONMENTAL SERVICES, DSA FORMNo.WOES004-0 (1117) 559-498-0240 wO SERVICE ORDER N0. FOR ACCOUNTING CALL: WOW 552.221-15550 N2431 180 AI' WORLD OIL EWRONMENTAL SERVICES,. 11 A&A CONCRETE SUPPLY#32 14287 EAST MANNING AVE,PARLIER CA 3648 A &A CONCRETE SUPPED INC-t 240 ! 1-559-498-0 P 4035 H MARIPOSA RD 3250 I=70TH STREET W.waRLDOILca P.cann ww Stockton, CA 85240 TRANSPORTER EPA#CAD028277036 LONG BEACH, CA 90805 a (209) 545-1980 (916):38:3-3756 f CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES A&005 88ZO (� JEFF 1pascual DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST## 5/3012017 CAL000268391 i= PART# DESCRIPTION QTY UNIT PRICE QTY PIU 'TOTAL OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE � f' /f2' OF USED METAL COIL AND GA�C?L€NE FILTERS t BATCH -Cr s 5treetw: 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(ETHYL-ENE GLYCOL SOLUTIONS) STATE CODE • Iii OTHER: Itt1}RI_l f`12L1'WO7AjJ"iA4fF,SOLID(FILTERS CONTAINING ESIGNATED TSDF: LTERNATETSDF: _ = r i T I; DRUMS P/U:-3— EMPTY DRUMS: FACILITY: BSC _ GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) SEP D 7 2011 By signing beiaw I hern*by certify that., (Waste oil generator/customer MU$T.check ONE of the following three boxes _ I Moi)Ihavenotmfxedanyofthe waste descn'hedabove wfthanyotherhmrdovswaste,the toWhalide content!,;USS than 1,003ppm,andthewaste does not contair�'an�PCOs.ih r t '}- - the applleabie Cailfornia used oil management regulations to determine this 1,true.I agree to accept the-additional chargas fer the disposal oFthis waste if the infoymatitt l have provided about this waste is incorrect 1=1921 have not mixed any of the waste described above with any other hazardous wasie,the total halide content IsGREAT ER than 1,000 ppm;and the wastd does not corttain any PCBs.I have provided ptapar documentation toVlorfd 011 I nviron nenta!Sesv[ce5 Yo rebut the gresumptfon that thiswaste vrm rnfxed with otherhazatdous waste.I agree to accept the additional charges far Tho disposal of this waste Ifthe information I have provided about this ynste Is irrcormct Ii EDOThiswaste Is Rom a tapkwhich coilectswaste ofl from househoWde-It-yourself'(W)and/orcvndltlonally exemptsmall ctianto generator iCi!SQGy squrces.To the best of my knowiedge,the pnlywasteoil contained inmyolYcuwcollection tankksoleyfromDlyand/orCFSQC,sources,(have nor mixed this wasteoilwith anyother hazardousvvasteorwasteolifiemothersourcatfagree toaccept the.addlr:onatchargesfarclkposai of this waste R the inrormation I have provided about this waste is Incorrect (All generators/customers MUST read the following text and check the asst a•ted box,) Ea)ff l am alarge quantity generator,I cxr*that I have a programin piaceto reduce thevaiumeand toxicity ofwaste generated to the degree I have determined to be econon imillypracTUble and that[have s etted the practicable methodof unatmenz,storage,of&posal eurrentiyavalloWe to me which minimizes the present and future threat to human fife and the envlydnment;Or,rf]am a sma!1 quanrfty generator,l hav made a goed falth effort to minrmize my waste generation and salect the bestwaste management method that is available to me that l can afford. This Individual sighing in the space set farthbglow on behalf ofIcustomer represents and warrants that he/she has the authoritym bind Customer.[Sat Iheeforgaing descrlpuons ofwaste,and materla)s are vue and accurate as packaged,marked and fabaled,are ready for transportation In accordance with applicable state and federal reguiatlors,and that Customer shall abide and be bound by the Szdndard Terms and Condltionz an the reverse side of this Service Order f o .1 u mer Sign tare Date Driver Si ature, Da Print Name Print Drivers Narne I;.