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FOR SERVICE CALL: <br />PARLIER <br />559-498-0240 <br />FOR ACCOUNTING CALL: <br />562-231-1550 <br />S <br />H <br />P <br />P - <br />E <br />D <br />T <br />0 <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />k <br />WORLD OIL <br />ENVIRONMENTAL SERVICESw <br />14237 EAST MANNING AVE, PARLIL--R CA 93648 <br />1-559-498-0240 <br />W WW.WORLDOILCORP.COM <br />TRANSPORTER EPA It CAD028277036 <br />FORM NO.WOES00-1--D (1/17) <br />SEr?vlcE C_RDrF NO. <br />CUSTOMER,11 <br />PURCHASE ORDER #� <br />ROUTE # TRUCK # <br />CON TACT NAME <br />�- ORDFR TAKEN BY ~ V HALIDES, <br />DATE REQUIRED_ <br />-DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA It <br />BILL of LADING/MANIFEST It <br />PART it <br />^- -DESCRIPTION � � - <br />C2TY <br />UNIT PRICE <br />QTY P/U <br />^ TOTAL <br />'- <br />TOTAL <br />CASH REC'D:CHECK#___-- _ <br />._ — ---- -- <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) <br />STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />STATE CODE --�-- <br />OTHER: <br />DESIGNATEDTSDF: <br />ACFERNAI-E TSDF: <br />DRUMS P/U:---. EMPTY DRUMS:-- _ FACILITY:____-_ <br />BSC <br />(jLINERAI UR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />By signing below.I hereby certify that;. <br />(Waste oil generator/customer MIDST check ONE of the following three boxes) <br />M#1) I have not mixed any of the 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 f CBs. I have complied with the requirements of <br />theapulicable California used oil managernent regulations to determine this is true.I agree to accept the additional charges for the disposal ofthis waste if the information I have provided about this waste is incorrect <br />M#2 I have not mixed any of the wast, 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 withotherhazardous waste. I 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 />1-1#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. I 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 I have provided about this waste is incorrect <br />(All generators/ customers MUST read the following text and check the associated box.) <br />#4) If I am a large quantity generator, I certify drat 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 I am a small quantity generator, I <br />have made a good faith effortto 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 andwarrants that he/she has the authority to bind Customer, that the forgoing descriptions of waste and materials are tine 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, <br />Customer Signature <br />Print Name `- - <br />Date <br />Driver Signature Date <br />Print Drivarc Name <br />