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FOR SERV{CE CALL: <br />n1xc�N a{=i={cE <br />1.80D•72%2879 <br />FOR ACCOUNTWG GALL: <br />562-231-1550 <br />f�Ef3 f3G7Y.a ;50741 <br />X957 VVF<5"1' I_AhIE- <br />r �rCr!{r(.ii�,Csl [8210 <br />SERVICE O>3DER <br />AeFiUi�Y �:�IVIH�3NM�Ni"AL SEFiiIiC�S, CiOA <br />ENVfRONMENTAL` CES„ <br />7300 CHEVRON WAY, DI 9562C <br />1-E00-727-26 <br />TRANSPORTER EPA#CAD028277836 <br />FORM NO. WOES004-8 (8/'18) <br />SERVICE ORDER N0. <br />N2 �5" 34 i <br />201 E, C.St�CtiARC� i?? <br />I-iRM1lM(�N'1'aIJ, %dJ 03U3i <br />(;tU01 ,334-37ti�F <br />CUSTOMER_# <br />_PURCHASE ORDER 1t <br />ROUTE # <br />TRUC6f # <br />CONTACT N:4ME <br />OROER TAKEN i3Y <br />HALIDES <br />�.`�;';���Fi <br />Gi=h-��a <br />RATF�IGKS(vi}T'Ii <br />ut�•f-Il7UI-c�D-I <br />f <br />''DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA lk <br />BILL of LADING/ MANIFEST # <br />i;1r.3t2atJ <br />�rtni?o4a <br />_ aar�:�sisrz���t <br />PART# <br />�� <br />DESCRIPTION <br />.QTY <br />UNIT PRICE <br />QTYPlU <br />TOTAL <br />I 01= <br />__ <br />ilfiFU ritlErtAL OIL AN�i Gt1SC3l_INE F-11._'1'�{2S <br />e 1 <br />/ <br />�'/3 /� <br />t:.>f"f�� <br />c)a. =1�:r�� c)i�unr r��t�i..acE�n�Nr- t'aa cr��tr�GE <br />� <br />/ <br />-,LCAVE,3[.ncicrtEteASErtilvrst�lvslTt:°' <br />E,A'iCHt-____._--- <br />TOTAL <br />CASH RECD: CNECK # r0 <br />WASTE DISPOSAL (NFORMATiON <br />NON-ACRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) � <br />STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (El"HYLENE GLYCOL SOLUTIONS) � <br />STATE CODE_ <br />OTHER:___`trYu.a;:faA laa�'aTinrinstAa� S -i = ccl tri {F(1 rFas t~r�NTA1NINr f]81i S'rATf_�nF »a <br />%i DESIGNATED TSDF: 'Y�`� it�tArdAGEl:i Ei•iT, ING, 650U US H[c344V.4Y 05, 1'U1.7A, A7_ 05365, fl7.9-:3:4-00:%H <br />_ <br />ALTERNATE TSDF: <br />,_ - <br />��--- _ <br />C%foss' G` e/9c.;`�,: <br />,�\canon[ Manager::>aYn Read <br />-- <br />DRUMS PIU: / EMPTY DRUMS: FACILITY:. DSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CNECK TFiE APPROPRIATE BOX) <br />ay signing Uelow i hereby certify that: <br />(Waste oil generator/customer MUST Check ONE ofi the fallowing three boxes) <br />Q !)i)1 have not mixed any of the waste described above with any othaY hazardous wasto, Iho tolai hslide content is LESS than 1,y00 ppm, and the waste does nut contain any PCBs. I have <br />compiled with the regtlirmnenis of the appgcable CaliFarnla used olI ntanvgement regulations to determine this is irUe. i agree to accept lhn addllional charges forihe tlispasal of this waste if <br />tna mmnnannn I Hoye nrowdea aaonunin waste la Iheorreet <br />r'Ll have not mixed any of the waste described above with any otherhazardous waste, the total halldo content is CiAF_ATEA than LOGO ppm and ilto Waelo does rwt centaln any PCas.l <br />have provided properdocumantatlon to World oil Environmental Serviass to rebut the presumplioa that Ihis waste was mixed with other hazardous vlaste. I agree to accept (he addillonal <br />charg=_s forihe disposal of Ihis waste itllw irtionnation lhave proviaetl aUout thia'waste is bmorrect ' <br />Qt'3)This waste lstromalankwh!cb collects waste oil irom household"do-if-yoursalY'(CIV)and/or condylonally exempt small quantity yeneralor (CESaG)sow'ces. To the best of my <br />knowledge, the Holy waste oil contained in my DIY/ CFSOG coilecllon Lank is soloy Iron p1Y and/or CESCO sources.) have notmlxed this wasto oil with any ocher hezartloas waste or waste oil <br />rrum ocher sources. I agree le accept the addifiona! charges for disposal of this wavte if the hifornlation I have provided about this waste is Incotreat <br />(All generators/ cusYorners MUST read the following Yext <br />I corlity that i hav0 a program in place io reduco Iho Volume and toxicity of waste ganeratod to the degree I have detenninetl to be eronomloally proctivable antl That I have serer..ted the <br />praoticnble method of treatment, sin:age, or diaPosal currently vvallabla to me, which mhtinikes the present and future threat to human Ilfe and the environment. <br />This Intllvlduai signing Ih the spare sal iortil below on behall of custmrer tepresanis and warrants lira[ halshe has the auihoriry to bind customer, Thal the fol'going descriptions of waste <br />maleriais ate Iran and accurate as packaged, marked, and labeled, aro ready for transporiollun In accordance with applicadle slate and terlaral regulations, and that costumer shall abide <br />by the Standard Terms and Conditions on the reverse side of Ihis Service OrdeY. - <br />5orviceOrdersvdlhanassociatedhazmdny^. tva Lmnnilost( ilhet'sho rpeultic or conoolitlatedJere subject to an EPA Fee. These er the FPA pass-through tae and administration <br />ai the ePyanitest pragl'um. These ices vary I(ased on Mmtl(ost (ypo, Applicable fees will appear an your billing invoice: <br />/��---1','� �' r, ., _' '._...._ L�� lam! �� / � ".–._.�� `-'.'%_" k/s� �Y— <br />�1 <br />Customer Sicirieture. Date � rivner Signa#ore /� Date <br />Narrle � 't�rint Driver <br />