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Sep 25 18, 10:57p p,1 74 <br /> FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NiDAYIDE5004-D (1117) <br /> 559-498-0240 SERVICE ORDER NO. <br /> FOR ACCOUAf7'ING CALL: <br /> 562-231-1550 <br /> cr- <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES.,, RE IV u <br /> s <br /> H 14287 EAST MANNING.AVE,PARLIER CA 93648 <br /> p i-559-49B-0240 "E P 2 6 2018 O18 <br /> P <br /> E AVM.WORLDOILCDRP.COM B <br /> D <br /> T TRANSPORTER EPA,#CAD028277036 0 ENVIRONMENTAL <br /> HEALTH DFnnuTRAENT <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICc DATE CUSTOMER EPA 0 BILL of LADING/MANiFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK 9 <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 CODE <br /> OTHER: <br /> DESIGNATEDTSDF: <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signi iq below I hereby cc-tify Jnc:: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q01131 have rot mixed arty of the waste described abo,*%-Ata arry o-her Irarardat;wast a,the total hatide Content is LESS than I=a ppm,and tit r•caste-..oes not contain arty aces.t have comp ivd with the rnlut•hanwa, of <br /> the, <br /> caoleCahfnrrriausecoil nanagemen.regulalionstedctermirle.I'lis ittlle.fag2ClCa:CCpithpMritinnalchargesrcwthe dispoalaft•ticwas_elfthe lnformadcitIhave orovidedaoojtthis was:eisincorrect <br /> [=921 ha—not miwany ofihrva rrd rr trod ahoue w'tllany o!ies I a. e"us waste,lhewr.rll-alidc uxnwitt Is GREATER Jim l,Oo(?µxn.and Tha waste d0eo not cortain any PCns,I <br /> Nave protrid_dGrepercocumen:ationtoftric llErvironmentalServicesmmhutthepresurptionthatthiswastea+asmoodwithotherfuzardouswaste.Iagree:oaccepttheadditionalcha-gestotthedisposalo`itis <br /> erste,.if the infot'nwtinn I h--provided about this.vnsto k;•,:orrect <br /> O03)This waste is from a tank which collects waste oil hom householc"do it-youneff'f 6 Y:andior condititxmilly exp npt small cuanr ty"erater IC ESQG i sourocs.To*..e hest of my knovvledga,the xly wave oil certainPd <br /> I n my C19!CESCG cat le.tian tank Is silty'rom DIY anc(o•CE5QG sources.I have not mixed this waxte ail with arty oth-•lazardous waste or waste oil fro nether sources.I agree to accept the aldaional chatges fa cispmal <br /> of this waste if the ireormatior I have prot•Ictec about this wr;Ol is fncormct <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> Milo)If I an d k•ge quantitygeieratcr,I certify iha: haft a pmWan in pkce to iedute the vrlume and=dclty:)I.vast,.generated;o the degre_I have determnad to beeconomicaliyprctkatle ane that I have <br /> selenec the prao cable n'ethod of treatment.siorage.or disposalcmrernly available tome wl kh rr4nimaes the mesent and fututethmat to hunar lire and the arreironmeM:orit I:,m a smal quarsity generator.I <br /> have mase a good talthefforttominim,2ernYwasteymomtion and select the best waste man,.)gerwrt method that is ovallable tome ti-at I can aFord <br /> Th s Individual s gr ing in:Ix space set lord:holaw on hehA of Custorre r tepresc rt s anr:warrants that ha!sin has the autkority to bind Customer,that the forgoing dewriotions of waste and materials an,true and accurate <br /> as packcged,marked ar d abxhmd.are ready fox ttanspor tailor in.wcord:4ice with a]pllcablo slide and federal rrgul>;lcris,and that Customer shall abldc u•rd be bound by..:he Sta idard T_mts.and Conditions on the revrise <br /> vde of tht,Service Order. <br /> i <br /> Y <br /> Customer Signature Date f' ..•-Driver 5ignaturie Date <br /> Print Name Print Drivers Name <br />