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176A SEPidCE CALL: SERVICE ORDER <br /> PARLIEP ASBU Y ENVIRONMENTAL SE RViCES, C13A FC. RM NO.VOFS004-D (1/17) <br /> 559-498-0240 <br /> FOR ACCOUNTING CALL; SERVICE ORDER NO. <br /> 552.231-1550 <br /> WORLDOIL <br /> ENVIRONMENTAL Si--:RV10ES,,s <br /> H 14287 EAST MANN€NG AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> F WNW.WORLDOILCORPCOM <br /> D <br /> T TRANSPORTER EPA#CAD028277036 <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVIC ,DATA CUSTOMER EPA# SILL of LADING/MANIFEST# <br /> PART'# D€SCRIIPZiON QTY UMPRKE QTY P/U TF�`I'r u <br /> TOTAL <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOU5INlk5TE;LIC�UltI7( 7NtE1ECiSL )LUfi€ IS) <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> I <br /> DRUMS P/U: EMPTY DRUMS:_ FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE 80X) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Ems}#1)I have not mixed any of the waste described above with any other hazardous waste,the total ha€ide cunten€is LESS than 1,060 ppm,and tite waste does not contain any PCBs.I have complied with the requirements of <br /> theappiicab€e California used of 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 is incorrect <br /> =42 1 have not mixed any of the waste described above with any other hazardous waste,the total-halide content k GREATER than 1,00€1 ppm,and the waste does not contain any AC3s.I <br /> have provided proper documentation to Wortd 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 rs incorrect <br /> =#31 This waste is from a tank which collects waste oil from hcuseho€d.do-it-yourself"(DIY)and/or mnditionafiy exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained <br /> in my DIY/CESQG collection tank is soiey from DIY and/or CESgG sources.I have not mixed this waste oil With any other hazaraovs waste or waste oil from other sources.I agree to accept the additional charges for disposal <br /> of this waste ifthe information i have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> CDq14)If I am a Iarge quantity generator,I certify that i have a program in place to reduce the volume and toxicity of caste 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 to me which minimizes the present and future threat to human life and the environment Or,if I am a small quantity generaror,I <br /> five made a good faith effort to minimize my waste generation and select the best waste management method that k available to me that I can afford. <br /> This individual signing in the space set forth below on behalf of 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,marked and labeled,are ready for transportation in accordance with applicable state and federal reguEations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br /> side o€this Service Order <br /> i <br /> Customef Signature M Date Driver Signature 's Date <br /> Print NarrdRPr€nt,Drivers Nab-le <br />