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SERVICE ORDER <br /> FOR SERVICE CALL: 1= <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM. NO. WOE5004-D (1 /77) <br /> 559-498-0240 SERVICE ORDER NO, <br /> FOR ACCOUNTING CALL: N2633738 <br /> 562-231 - 1550 G <br /> WORLD <br /> (i <br /> ORLD IL <br /> ENVIRONMENTAL SERVICESPA <br /> 5 14287 EAST MANNING AVE, PARLIER CA 93648 <br /> H 711 MATERIALS INC - 711002 1 -559-498-0240 <br /> P 2714 STAGECOACH PO BOX 3191 <br /> p W W W.WORLDOI LCORP.COM <br /> E <br /> S T OCKTON, CA 952.15 TRANSPORTER EPA # CAD028277036 MODESTO, CA 95354 <br /> T <br /> (209) 9434730 (209) 943-4730 <br /> t <br /> CUSTOMER IT PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> 711002 ER-86 2Q � y HANK avelazquez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # <br /> 7/25/2018 CAL000264132 ' <br /> C�1-b t9t� 64G9cz.s3' <br /> PART # DESCRIPTION QTY UNITPRICE QTYP/U TOTAL <br /> OILY SO OILY SOLIDS PER DRUM X $ 125.00 $375. 00 <br /> 55-OTM 55 GALLON OJT DRUM (RECONDITIONED) 3 $52. 00 9, $ 170, 04 <br /> EMS EMANIFEST EPA FEE & ADMIN - SITE SPECIFIC MANIFEST 1 $10. 00 $10. 00 <br /> BATCH # <br /> i <br /> Effective 711 /2018: Service orders with associated haz waste manifests (site specific/consolida ed) are rubleto an EPA Fee, ees cover PA pass- <br /> t -ou a a t - .I Lon murrinvoicia <br /> CASHREC'D: CHECK # <br /> t <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE COPE_ <br /> OTHER: �--� <br /> DESIGNATED TSDF: .S• 7Df� (R �k�t2Z Lam' '�rI 'S� ?va 2"ZZ <br /> ALTERNATETSDF: L/>OOry`I03fJ <br /> �`__ ter• +,�� �I itnr� oerneu en Ir. lrn vn� n�e�rlr;�Mapago�-Todd-Atffit <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> t -'�'�� �'l, irLtl 1�% LSI ' it`ll <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) AUG . 0 REC'Q <br /> By signing below I hereby certify that: � .v <br /> (Waste oil generator/customer MUST check ONE of the following three boxe-s}-- <br /> C3#n I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than imo ppm, and the waste does not contain any nob. I have complied with the requirements of <br /> the applicable California used oil management regulations to determine this Is true. I agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste is mcorrec[ <br /> na <br /> p#21 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than Loop ppm, and the waste does not contain any PCBs. I $, <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with otherhazardous waste. l agree to accept the additional charges for the disposal of this Ef <br /> waste if the Information i have provided about this waste is incorrect 3 <br /> E <br /> O#3) This waste is (roma tank which collects waste ail from hausehold 'do-ftyourself"IDIYI and/or conditionally exempt small quantity generator (CESQG) sources.To the best of my knowledge, the only waste oil contained <br /> In my DIY/ CESQG collection tank is splay from DIY and/or CESQG source5. 1 have not mixed this waste oil with any other hazardous waste or waste oil from other sources. ) agree to accept the additional charges for disposal <br /> of this waste if the information l have provided about this waste is incorrect <br /> (All generators/ customers MUST read the following text and check the associated box.) <br /> O44) 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 <br /> selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment; Or, if l am a small quantity generator, ) <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 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 ofwaste 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. k <br /> nx o <br /> Cu mer Signature Date Driver Si a ure Date 000 <br /> Print Name Print Drivers Name <br />