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r <br /> FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO,WOES004=D (1/17) <br /> 559-492-0240 WQ SERVICE ORDER NO, <br /> FORACCOL)NTING CALL.: tlt1OGIY <br /> N2431130 <br /> 562-231-1550 <br /> AF <br /> OLD OIL <br /> 1= <br /> ENVIRONMENTAL SERVICES,,, <br /> s A&A CONCRETE SUPPLY#;t32 14287 EAST MANNING AVE,PARLfER CA 43648 A &A CONCRETE SUPPLY INC- rr <br /> H <br /> 1-559-498-Q2-40 <br /> P 4035 E MARIPOSA RD wvvw.wnf�LDalLcol��coM 3250 E 70TH STREET` <br /> is <br /> T Stockton, CA95240 5240 TRANSPORTER EPA#CAD028277036 LONG PEACH, CA 90805 <br /> 0 (209)5,46-1980 (916) 363-3756 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES <br /> k <br /> I <br /> Fi&005 S6 2,0JEFF ipaseual <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 9 BILL of LADING/MANIFEST# <br /> i' <br /> 8130/2047 CAL00026839l <br /> PART# DESCRIPTION QTY UNIT PRfCE QTY PIU TOTAL <br /> OFDR OIL RLTER DRUM REPLACEMENT-NO CHARGE <br /> OF USED METAL OIL AND GASOLINE FILTERS <br /> BATCH# <br /> -Crozs Stream: _ TOTAL <br /> CASK RECD: CHFCK# Account Manager.Steve Gately -If' <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USE,D OIL/MIXED OILS) STATE COOS 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYL-ENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: Iy ou--RCf2Q'V 1Q7A <br /> ESfGNATED TSDF: <br /> LTERNATETSDF; l <br /> I <br /> DRUviSP/U:--L EMPTY DRUMS: FACILITY: BEC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> SEP 0 7 2017 <br /> aysigningbeiovri hembycertlfy that: - - <br /> (Waste oil generator/customer MUST.check ONE of the following three boxes <br /> C3NY)[havenotmixed any ofthe waste dostnbedabove with any other haxardoutwaste,the total halide content ls Liss than 7,naappm,and the waste does not cantalr�pp PC6s.lh <br /> the applicable Callfornfa used oil manugement regulations to determine this is lnre.I agree to acceptthe.additional charges for the disposal of this waste if the TnfcrmadoARavt provided about tFis waste is incorrect• <br /> €-IN2lhaveriotmixedanyofthewastedescrlbedabcve.wlthanyotherhazaidousmUierthetotalhaiidecontentIsGREATERthan1,U64ppm,andthewastddoesnotcontainanyPCBs,i f <br /> have provided propef documentation to World Oil Environmental Services to rebut the presumption that this-wasievras mixed with other hazardous wastd.I agree to accept the additiona}charges for the disposal of this <br /> wasm Iftlte information i have provided about this waste Is incorrect <br /> •r. <br /> M#a)Thiswaste is Ram a tank wftich collects waste oil from hovsdtold°do-it yourself"(OIY)and/orcondttlanally exempt small qw ntfrygenerawr(CESQG)sources.To the but of my imcwledge,the only via stz oif contained <br /> in my DIY!CESQG collection tank is saley from DIY and/or CBQG sources.[have not mixed this waste oil w]th any other hazardous waste or waste all from oilier sources,f agree to accept the addlticnal charges for disposal <br /> of this waste if the information 1 have provided aboutthiswaste Is Incorrect <br /> (All generators/customers MUST read the following text and check the 8bciated box.) <br /> - <br /> 1171 am a large quaritiry generator I cextifythatl havea program In plweto reduce the volume and to*icityol`waste.yeoerated toihedegreeI have determimadtob-c eccinDmlcallypracticable and thatfhave <br /> M <br /> the practicable method of treatment,storage,or disposal currently available to me which minimizes the present andfuture threatto human life and The envlrorment;Or,if lama smai(quantity generator 1 <br /> ha madea goon faith eKortto minimize my waste generation and selectthe best vmste management method that is available to me that I can afford. <br /> This individual signing in the space set Forth h!lovr an b ehalf cf Customer represents and warrants that he/she has the authority to bind Customer,that the forgoing deicrlptlans of wasteand materlaIs are true and accurate <br /> as packaged,marked and fabe44are ready fortransportatlon In accordance with applirable state and Inderal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions nn Wte teverse <br /> side ofthls Service Order. " <br /> © -is <br /> (P/ /L7- <br /> DateDriver Si azure' Da <br /> Print Naive Print Drivers flame <br />