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A Am f ; f -- - -- _. :I AVe ti ( ,rr 'i0 ol., T i ' fV r11( TRC� NSPOIA! T ( I c. t' : , � ;lt ; . t! '• J ' r' r ; t cy ',�l''r r� F�\ i� it . ..fi . �.A 9.Gi .33f? 667- 7 % L ? f2� U9) ilC) r- ! t' � ; 1 = S Ofoil EF; PURCHASE ORDER tt ROUTE _ ' ItU � E • t ' 1 , tr , ;iAp1E I ORDER TAKEN BY HALIDES - — irA A I lk AAA I bar. 4 Am. . . DArk REQUIRED DATE ENTERED NEXT SERVICE DATt C i Tt ) t P cPA BILL of LADING/ MANIFEST Pr -- -- - - ._ --__ _-- --- _ _ _ �— -- -- p 4i9t20 '19 � LU )Gu3G � 9 �t 16 O 703 q ( JJ ) t PART =' DESCRIPTIONAm . OTY UNIT PRICE QTY P/U TOTAL 'WOtC U- SED OIL SERVICE Cl iARCUL $ 65. 00 $65- 00 i�y0 i iSED OIL / MIXED OILS SI). 00 � So $ 0 . 00 r � C SCJ TOTAL CASH RECD : ___ - __ _-- CHECK i1____ �l./�-- -- --- -- - -- - _1 --- AAA mm� _—_—_- -. .___- __- mm - A __. ___ __-_-- WASTE DISPOSAL INFORMATION NOWFICRA HAZARDOUS WASTE , LIQUID ( USED OIL/MIXED OILS ) STATE CODE 221 NON - RCRA HAZARDOUS WASTE , LIQUID ( ETHYLENE GLYCOL SOLUTIONS ) STATE CODE __._ — OTHER : S DESIGNATED TSDF : _ - lrSS1ftY_EN11tiUltFlEh1TAL_SERt1ICES.CERES, : 9 L : OFt �iu•l Rn. , GERES, . i+ 95359 ( 203)5d1. i8r CALOf)0393680 ALTERNATE TSDF : _ . . -------- - - _ . -- ------ AAAAAA Cross Streets-- I^UR+t1iEF2L-)LIN-N- r. U-T- AUTOMOTIVc - :- -. - _ _ . _ _ . . _ __ e? cenurt. t� anagec Sam -Bead_ ____.,___. DRUMS P/U : EMPTY DRUMS : ._ - -_ --_ ___ FACILITY : _. _ _ _ _._ -_. BSC .. .. . _ . . A AAAA GENERATOR WASTE CERTIFICATION ( PLEASE CHECK THE APPROPRIATE BOX) ey signing below I hervby certify that: ( Waste oil generator/customer MUST check ONE of the following three boxes ) �; xt ) I have not mix ad any of Ilia waste dosetibod above with any other hazardous was to, the total halide c�taent a IJiSS than 1 ,000 ppm, and the waste does not contain any Kea, I have compifnd with the requlromonto of Ilio applicable California usod oil management regulations to dincrenhw this m: nue I wire to accept the additional charges for the disposal of title whale it the Information I have provided about this waste Is Incorrect Li r2 I hnvo not mixed any of the waste described above viWi tiny other hnzardcus vmste , the totai halide commit is (3f1E<J[H thou 1 ,000 ppm , and the wa sto does not contain any PC©o. 1 have provided proper documentation to World Oil Environmental Sotvicvs to rebut the presumption that this :re ;uc was mixed with other hazardous waste. i agree to accept the additional cllnrges for the disposal of lhls waste Il Ilio Information I have provided about this waste Is ITICarrat'1 i !L AJ) This waste Is from a lank which collects waste oil from household "do-Il -yotnnelY (OIY) and or condiGot%4ihy oxcmpl small quantity generator (CESOG ) sources. To the beat of my I i. nuv+ledfie, Ilia only waste oil contained in my DIY! CESOG collection link is soiey (rain tilt/ and/or CEf50G e. ourees I hnvo not mixed this v=usle oil with tiny other haraidoua wosto or waste oil Ifront other sourcha. I agree 10 uCcepf the additional charges lot alsposaf of tilt% waste If the mformattrm I navy, pro% nlyd ;iiicul this vvnatn I5 incorrect ( All generators/ customers MUST read the following text I certify that I have a program In Place to reduce the volume and toxicity of wasto generated to the copwc' t h,tv : dela '^.:It ec to be eranomlcaliy pt wet ica life and that 1 have anfeeiad the practicable method of tteautioru, storage, or dispoul cut tarift avnilitWo to inn which m nir•rizt•s ati- A t -ort and rn �m Ihre;a to human life and Iho anv+roruneni Tills individual sitz 1 tot acv sot forth below on betail ul customer mpros0nls and warrants vier he?silo Isi . a tuthority to hind customer, mat the forgoing descriplions of waste ar.d mat0dois tire, ro hue a sec .auto urs packaged. narked, and iibolod, are road , tot trancportaGan ht nccoioance - npphcnbte state and ledotal feguinliona , and thin customer shall uhlrta by the Smndr rd Ter and C ndlilons on the reverse side of thht Service Order Svrrice ordef s w' t n t �oclated hnzatdous waste mnniloM (either vile : pecih , v uxr. t. n .1.Cen kilo d I o . ': PA Pe ((((((""""""''""''''''''��rc Jr % ever the EPA pussdhrough leo and edminlatralian of uie ell mite . pr r , t These fees vary based on fdandrist lype APPlicahle Icra v+ih oppoor on * *) rrif . ii , vr,i 41 A CLIS101 ., r Signature Dat GD r 5 gnature Date r Print Namie ;= rint Driver Name