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FOR SERVICE CALL: SERVICE ORDER, <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) <br /> 559-498-0240 'VIVO 1000 j SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: VtlC3DLY Q Y <br /> 562-237-1550 N2476&1 <br /> AF 110 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,„. <br /> StII:F Y LUE� ���$ 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> H OADC3SE INC <br /> 1 559 498-0240 <br /> P IB48 E HAMMER LN 1471 SHORE ST <br /> E MONTHLY BILLING WO&OF WWWWORLDOILCORP.COM <br /> S(�iCKTC>At,£%A £ 1Q TRANSPORTER EPA#CAD028277036 V�fEST SACRAMENTO,CA 85591 <br /> /«n>'a "S32-8760 <br /> (91e) 37S-1155 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> E is,66 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST <br /> 111.--,0120 CALOW294439 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> UI t.iiZ <br /> OIL FILTN DRIUK RE+4,J EW.1,1T.�df3�HA4{�t, 1 <br /> l^. AE RL t31L AND GASOI-fflt FILTERS <br /> ALL DRIVE iS MAKE SURE TO LCX:%SIDE HATCH WHEN DC44F. BATCH Ik <br /> D',( DIXON , 01(100152EXPIRED TOTAL <br /> CASH REC'D:____ CHECK# "'Ca'alot Aaxia'rt; Steve c:tdr.t;y <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 /> DESIGNATED TSDF: <br /> ALTERNATETSDF: I. ''` '` `'t 14 's <br /> DRUMS PIU:----_ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that. <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> t341)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 PCBs.I have compiled 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 isir?torrect <br /> 0421 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,0W 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.I agree to accept the additional charges for the disposal of this <br /> waste if the information I have provided about this waste I%incorrect <br /> O113)This waste is from a tank which collects waste cul 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 DIYi 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.I 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 /> O04)If I am a large quantity generator,l certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to he economically practicable and that I have <br /> selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment;Cr,if I am a small quantity generator,I <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 beharof Customer represents and warrants that he;'she has the authority to bind Customer,that the forgoing descriptions of waste and materials are true and accurate <br /> as packaged,4-rked and l9beled,are ready f r transrlorta on 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 5 ice Order. <br /> {{��� ./ 1�l� r :L h% �r � tel' � i � fj f�• f j' i��, '� tf ;:. r / <br /> Cu o Sign tti�e 1/ j Date Driver Sigpature Date <br /> !� <br /> Print Name / Print Drivers Name <br />