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FOit SEF1ViGL GALL: <br />PARI_lER vv0 <br />5,59-498-0240 <br />FORACCOUNTINOCACC: WODIY <br />562-231-1550 AF <br />PEP POYS #0711 <br />4987 VJES7 LANE <br />STOCKTON,CA 95290 <br />{209) 952-1222 <br />ASOURY ENVIRONMENTAL SERVICES, i�BA <br />� � � <br />r ,r <br />W W W.WORLDOILCORP.COM <br />TRANSPORTER EPA # CAD028277036 <br />FORM NO. WOES004-D (1l17) <br />SERVICE ORDER NO. <br />N2595712 <br />THE EC GROUP <br />201 E. ORCHRRD ST <br />HAMMONTON, NJ 08037 <br />(800). 334-3794 . <br />CUSTOMER# <br />PURCHASE ORDER# <br />ROUTf_# <br />TRUCK# <br />CONTACTNANIE <br />ORDERTAKENBY <br />HALIDES <br />REP3 <br />)T}�"- <br />- <br />DATE REQUIRED <br />DATE ENTERED <br />NEXTSERVIC DATE <br />CUSTOMER EPA'# <br />BILL of LADING/MANIFEST# <br />C 1Fi62844 <br />� u <br />PART# <br />� DESCRIPTION <br />QTY <br />UNITPRICE <br />Q,T�yY/,PN <br />TOTAL <br />VVO <br />USED OIL f MIXED OILS <br />135 <br />joW <br />�; <br />�tP <br />�-__'')l <br />Q� <br />- __* <br />BATCH # <br />J <br />Cro <br />s <br />Streets: <br />TOTAL <br />/ /O <br />!! rr�� <br />CASH RECD: <br />CFIECK# <br />WASTE DISPOSALINFORMATION <br />NON-RCRA <br />HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) � <br />STATE CODE 221 <br />NON-RCRA <br />HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />� <br />STATE CODE_ - <br />07HER; <br />UESIGNATEDTSDF: ASBURY ENVIRONMENTAL SERVICES-CERE5 1920 MORGAN RD, CERES,CA 95358(20915d1-1826,CAL000393680 <br />ALTERNATETSDF: <br />- <br />__ <br />DRUMS P/U; <br />EMPTY DRUMS; FACILITY: <br />BSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKI'HE APPROPRIATE 60X) <br />Bysiyning below I hereby certify that: <br />` — (Waste oil gener'atorlcustomerMOST check ONE of the following three boxes) <br />f�:.l) I have notmixed any of the wastedes<rlbed above with anyother haratdous waste, the total haliAe content Is LE55 than'(,000 ppm and the wane does not mnraln any PCes.l have <omplledwtlhthe requirementsoE <br />/ he appiicahle California used oli management regulallons[odetermin¢thls is true.l agree to accept the addldonal<harges for the disposal of lhiswazre if the Information lhave pmvlded about thissvaste is incorrect <br />Qp21 haveno[ mixed ahy o! the wastodesalbed above with any other hazardous waste, the tonal halide content is GRFlsTER than 1,000 ppm, and thewastedoes notcon[ain any PC135. i <br />have provided proper documentation to World qil Environm¢nWl Szrvices tocebut the presumpllon That this waste was mixed with other hazardous waste.i agree to acceptthe adtlilional charges forthe dlsposal of this <br />waste if theinformationihav¢provided about lhls waste is incorcect , <br />Ox3)Thlswaste Is from a tank whl<h collects waslepil from household'doibyourself' IUIY) andlorcondi[ionallyexempt small gpandtygenerator (CESQG) sourms.To the best of my knowledye, the only waneoi(cpntained <br />my DIYlCESQG coile<tion tank Is Soley from DIY and/or CESgG sources.) have not mined thlswas[e oil wlih any other hazardous waste orwasteoll from othersources.l agree to accept the additional charges Eor dlsposal <br />o(Ihis waste if the intormationlhave pmvlded about lhls waste is lnconect <br />(All generators/ customers MUST read the following text and check the associated box.) <br />R ) iE I am a large quantltygenemmh I cerd(y Ihat I have a pragam In plate to reduce thevolume and Wxklry ofwaste yenerated to the degree I have determined m be economically practicable and that I have <br />e acted the pacllcable method of treavnengstorage, ordtsposal cnnentlyavailable to mewhich minimizes the present and future threat inhuman lite and [he environmenp Oylf I am a small tloangtygeneramr, I <br />have madeayondfaitheffortMminlmlze my waste generallon and select the best waste management method that is available to me thattcan afford. /�'� <br />setfonh below on behalf of Customer lepresenls and warrants Ihat hMshe has thcautl <br />re ready for Iransportallon In accordance with applicable stale anJ federal segu6�tions, <br />�'r, <br />Name <br />materials arc tni a and actuate <br />and Conditions on the reverse <br />�7zzl <br />Date <br />