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FOR SERVICE CALL. SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-D (1/17) 559-498-0240 wo SERVICE ORDER NO. FOR ACCOUNTING CALL: 562-231-1550 WODIY 4 AF WORLD ® IL ENVIRONMENTAL SERVICES,,. s 14287 EAST MANNING AVE, PARLIER CA 93648 711 MATERIALS INC - 711002 1 -559-498-0240 F 2714 STAGECOACH WWW.WORLDOILCORP.COM PO BOX 3191 E STOCKTON , CA 95215 TRANSPORTER EPA # CAD028277036 MODESTO, CA 95354 0 (209) 943-4730 (209) 943-4730 CUSTOMER It PURCHASEORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES 711002 86 ZJ'7✓� COOPER evelazquez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIF1EST # f , 9/21 /2017 CAL000264132 6 7q / V VL-- PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 55-O/TM 55 GALLON 0/T TOP DRUM (RECONDITIONED) 2 $52, 00 Z-. $113.36 N/R $O NON-RCRA SOLID PER DRUM 2 $165. 00 `2- $330. 00 BAT Cro s Streets: NH VAC PROFILED INTO YOLO TOTAL CASH RECD: CHECK #. Account Manager: Steve Gatel WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: DESIGNATEDTSDF: ALTERNATETSDF: DRUMS NU EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) j By signing below l hereby certify that OCT ® 3 2017 (Waste oil generator/customer MUST check ONE of the following three b( xes) O91) l have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than l,noo ppm, and the waste does not contain any P compiled with the requirements of the applicable California used all management regulations to determine this is but. l agree to accept the additional charges far the disposal of this waste if the Information l havfdMRladaboWdMsvaastNNvawreM••••• =#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 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 waste if the information I have provided about this waste is incorrect =93)This waste is from a tank which collects waste oil from household"da-it-yourseif'(OIY) and/or conditionally exempt small quantity generator(CESOG) saurcws Tcr the best of my knowledge, the only waste oil contained , _ in my DIY/CNIG collection tank is soleyfrom DRY and/orCESOG sources. l have not mixed this waste oil with any other hazardous waste or waste oilfrom other sources. l agree to accept the additional charges for disposal'+' `-s of this waste if the Information i have provided about this waste is incorrect ! (All generators/ customers MUST read the following text and check the associated box. Kif l am a large quantity generator, I certify that l have a program in place to reduce the volume and toxicity of waste generated to the degree l have determined to be economically practicable and that l have s teed the praciicabl ethod oftreatment, storage, or disposal currently available tome which minimizes the present and future threat to human life and the environment, Or, if i am a small quantity generator, l ,. havemadeagoodfa" effosteo minimize my waste generation and select the best waste management method that is available tome that l can afford. XrSI In the space set forth below on behalf o(Customer represents and warrants that he/she has the authority to bind Customer, that the forgoing descriptions ofwaste and materials are true and accurate and labeled are ready far transportation in accordance with applicable state and federal regulations,and that Cus4DrIvera" nat bound by StandamlTerms and Conditions on the mo me f(p der. € ature Date � ate I Print Name Print Drivers Name