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� J <br /> FOR R VICE CALLS ' SERVICE ORDER oix 4FA $URY ENVIRONMENTAL SERVECES, DBA F9 NO. WCC t� �� <br /> I=OR.ACCOUNTING CALL: <br /> 562-231-16M 0WORLDOIL <br /> 5 ENVIRONMENTAL SERVICES. <br /> TIIKj A 3UN M�r��4..Ri�FLj� RLS,iR; d�si�r:; foo rs�vpo800-72�879� CA 95620 <br /> E WWW.WORLDOILCORRCOM U--` H Ajwbmy GC4IAIUNp*8. II4C <br /> .RTVG1 TC44. CA 06206 TRANSPORTER EPA#CAD0282T7036 PO WX s 3= <br /> ° r-'tiR 44-2w0 aivir-SE, Cr`v$2= <br /> CUSTOMER# <br /> -0URCHASE ORDER# ROUTE# TRUCK* CONTACT NAME ORDER TAIWN '- <br /> Y3 <br /> BATE ED NEXT SERVICE DATE CUSTOMER EPA+f BILL of <br /> PA�i'# DESC- IPT10N <br /> OIL,, OIL& OTY UNIT PRICE <br /> "61111-, Ehl-� tri �► 4 K�rly�lf± `I i- `F._'�jl� trim S1T e <br /> t <br /> $"SOO &NOD <br /> 4 , <br /> CASH REC-& � " CtIECK# <br /> t ' WASTE DISPOSAL 064DRUATION <br /> lR'ftWVAM LIQUID(USED OIL./MIXED OILS) STATE CODE M <br /> t'0N*CRA Ki4Rp0U8 WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) <br /> OTHSTATE COD <br /> M,. <br /> DESKMIATED TSDF. <br /> ALTERNATE TSDF• — - — - -- - - f. <br /> —77-7- <br /> a <br /> pBUMS P/tI-_ EMPTY DRUMS: -_ FACILITY:_ BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE 861Q.-7, <br /> By betAw 1 hereby aermy otic <br /> (Waste Oil generator/customer MUST check ONE of the following three boxes) <br /> haw#at.t <br /> ft*any d MICwa""""law abow""my Dew lrzerdotu wast*,an urm ftsmo cxr dow is i ms urn i mo Qpn,,cad ur waeI dor.rm*or&* "pca&I,hdw.- <br /> "ft**"" <br /> ou trrarra0ement raQulauona m dagiad0e Writ w tare.I scree to aogpt tl1a addRbna rear torthe rtMpo�eaLoltltlairgbisil! <br /> the lntefaraYtlRFtrNo <br /> Q I.!F have not W duo of the sone waacribrd strove w e w olirr tramdour waata,ttr tote)hWde owdeat Y GREATER than J.ono ppm,and ttu*wsaM <br /> hawk PtaMdad ReglK depAtlan�gw id 1AIoAd t711 Eow I havews 10+hour ttrlalwtisre fa hreorreot Oft waste was ndred w th other hazardous scot*1 rq�p ppQ��pPoew <br /> t <br /> ahrEaa for 14aaalr'oaal pt thR 1Ui,te■dra Mtonrrauc0 I bare <br /> m lA tfd.Mi 1rliatn i,taak wddetr ea11ecla warar a1i tram lrouaatrow do Ft-voor..tr tpir)andror conafno„eBy,><„upt Wren <br /> bom oQtihlilNd M tttYD/Yi't;BOCtG collectlorr tank h coley from MY wx cIEBQtt aourcer f haus not mf vweRs oil arrywol� <br /> ttorMdii aria atrppe ilgaddtHorrli etrrpas for edailoeai of tide warlr H rhe 1rr[ormequn I Marra Provided About thea mew is tnoorteor ala°E <br /> A. <br /> (All generators/customers MUST reed the following text <br /> 1 cefRlir mat haws Pmorm b oM f o redurr ur vohane and toxW or vnue <br /> Praefsla M* 6[ kr�J+pp or dieppr y swmaly av+Yab e m me which minlnd o dew-r have determined to be @MW Y WMyaable and tpeH trsre epagted 1 <br /> 1711* he <br /> Pr'Mmd and tr M threat to tome 1110 and the anyhoM fit <br /> orad Itt T"air*M WOW an b"W of tl+r bMw Y'IFraeangr and aiaerarrel tMa hadrtra hr 1110 <br /> b11 t1w. 7rrer*ltd and •an mfr for trsnaportauao to aromiiarrce+weir ar'd1O h'bind oultoarar,Etat aY <br /> an tira nrversa rtda a tri[*Bervioe order. appMeaWO cal.arq tadard ,y,aet <br /> alltardfadwpo(pwita�armus ween a wMert faittrr Atte aPsrJeic or c�Wan arP�aet jo an EPA Fw. 7lraae tree actYa►tlta EPA paaM{wnpl11ir tea alld <br /> S vay booed on rlarutest type. AppNcabie tees>rNl t� invoice sophopowim <br /> t V/* + <br /> t f• <br /> Dt31ba naum <br /> Driver Signature �/ <br /> 110 <br /> Orlret MRma <br /> Print Driver Name j;�x <br />