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SERVICE ORDER <br /> FORSERVIOE CALL: <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOE5o04-D (t/17) <br /> 559-498-0240 WO - SERVICE ORDER NO. i <br /> l <br /> FOR ACCOUNTING CALL: WODIY N2471824 <br /> 562-231 - 1¢50 <br /> AF <br /> WORLD ® IL <br /> ENVIRONMENTAL SERVICESax <br /> s 14287 EAST MANNING AVE, PARLIER CA 93648 <br /> H 711 MATERIALS INC - 711002 559-498-0240 <br /> P 2714 STAGECOACH PO BOX 3191 <br /> p WWWWORLDOILCORPOOM <br /> ° <br /> S71 OCKTON , CA 95215 TRANSPORTER EPA If CAD028277036 MODESTO, CA 95354 <br /> Q (209) 943-4730 (209) 9434730 <br /> CUSTOMER PURCHASE ORDER # EROUTE4 TRUCK # CONTACT NAME ORDER TAKEN BY711002 -86 HANK jpacheco <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL off LADING/MANIFEST # <br /> 11 /9/2017 CAL000264132 c L"5 65055/ <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OILY SO OILY SOLIDS PER DRUM $ 165.00 <br /> 55.OIT'M 55 GALLON OfF DRUM (RECONDITIONED) $52. 00 <br /> i <br /> i <br /> PLEASE PI KUPASAR THANKS. BATCH # ; <br /> ` � I <br /> Cro s Streets: NH VAC PROFILED INTO YOLO TOTAL <br /> CASH RECD: CHECK # Account Manager: Steve Gately <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) STATECODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: <br /> ALTERNATE TSDF: <br /> DRUMSP/U: EMPTY DRUMS: FACILITY: BSCif - <br /> i <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) 7 <br /> By signing below l hereby certify that; P NOV 2 � �O � • ' <br /> (Waste oil generator/customer MUST check ONE of the following three boxes)., <br /> . [=#I) [ have not mixed any ofthe waste described above with any other hazardous waste, the total halide content is LESS than 1,000 ppm, and the waste does not contain any PCBS.I have complied.with the,requiresnents of <br /> the applicable California used ail 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 Incorrect - - <br /> =#21 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 PCBs. I <br /> have provided proper documentation to World oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. ) 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 /> L.1#3) 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 oil contained <br /> in MY DIY/ CESQG collection tank is coley from DIY and/or CESQG sources. ) have not mixed this waste oil with any other hazardous waste or waste oil from other sources. i agree to accept the additional charges for disposal <br /> Of this waste ifthe information l have provided about this waste is incorrect <br /> (AII generators/ customers MUST read the following text and check the associated box.) <br /> 041 If i am a large quan[iry 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 /> elected the pro <br /> e qu le method croons <br /> f treatment, sroraI ve disposal currently available [o me which minimizes the <br /> present and future <br /> threat <br /> to hum <br /> an life and the environment, or, Iflamasmail quantity generato0l (. <br /> madea good faith at on <br /> minimize mywaste generation and select the best waste management method that is available to in thatIcan afford. t <br /> Thise ividualsigning in the space set forth below on behalf of customer represents and warrants that he/she hasthe authorityto bind Customer, that the the <br /> descriptions of waste and materials are trueand accurate I <br /> specks ged, 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. <br /> 'H7 <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Driver ame <br />