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SE 11 <br /> ORDER a <br /> } SERVICE CALL;^ ~ FORM NO WOE5004-D (11/ 7), <br /> AIei- I w I lEt3 SIIRY I NV11 1�dtV1 NTA al i Vl. GES, DSAWW <br /> ' I ' ll SERVICE ORDER NO <br /> 55J 98. Cf2dO�' 1 r ' <br /> �i <br /> FOR ACCOUNTING CALL �: . "� . <br /> Zell e N <br /> r 562 2i el <br /> 1550 ' <br /> ENUIRONMENTALSERVICES <br /> SM <br /> -el14287 EAST MANNING AV E,' PARLIERCA' 93648 " yEAS't' BAY T� <br /> leell <br /> OWI'' I� Tfif � 1 559-498-0240 - 2200 U {� � <br /> d11 APE RDWill <br /> �g p w WW.W WORLDOILCORPCOM ' <br /> ' ` F�►{ IEL�3:` �► 1 � ' <br /> r i> 11 <br /> �� � il, lile, "` '4 " TRANSPORTER EPA # CAD0282"77036 <br /> o { <br /> 7 {713719 <br /> > t <br /> ;CUSTOMER #„ PURCHASE ORDER # ROUTE # TRUCK #el I <br /> CONTACT NAME ORDER TAKEN gY c HALIDES'- <br /> 924 JUSTIN I _ ?� 91, <br /> I � DP,TE REQUIRED ; DATE.ENTERED EA8821 /I ki 14 ell 9F <br /> NEXT SERVICE DATE_ CUSTOMER EPA # <br /> BILL ofLADING/MANIFEST # <br /> c ; r C1: 0 . � , <br /> E ee4 <br /> t _ UNIT`PRICl , QTY PI,l1 T � At <br /> f'AftT We <br /> DESCRIPfiON " ij <br /> QTYI el <br /> d { „ <br /> ILiI <br /> PAGED DMho <br /> BATCH „ <br /> orttats.' AIL 71 -M9 I*II <br /> TOTAL , .a . <br /> � ill 11 IN 111 11 �a=00A Man ger. e tit <br /> 1 ma <br /> CASH REC'D:. , CHECK # , <br /> WASTE DISPOSAL INFORMATION <br /> STATE CODE 221 <br /> NON—RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br /> OTHER: £f <br /> Wi <br /> DESIGNATEDTSDF: � cV: � ` <br /> 43A�+ru IMA <br /> ALTERNATETSDF: <br /> FACIt fTYc_ BSC <br /> DRUMSP/U : EMPTY DRUMS: x <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> F above with any otiisi hazardou ; waste, the total halide content is LESS than 1 ,000 ppm, and thihe s wastastee f theInformation oes net tI havain any e pr sided about this svastu's mcoq et <br /> ed Il the requiliel 9 ts of <br /> f� iii.rve not mixed any of the caste rfuttits-tf <br /> appiivible California used oil mana +_r'nent r �Jui tions to determine this is trite I agree to accept the additional charges for the disposalo <br /> [� a21 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 7 ,OD0 ppm, and the waste does not contain any PCBs 1 <br /> hbv'e provided proper documentation to World oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste, l agree to accept the additional charges for the disposal Of this <br /> waste if the information I have provided about this waste is incorrect <br /> sourcesJo <br /> t of my <br /> e, the <br /> nly waste oil <br /> tank vrhich collects waste oil frorn household 'do 11-yourself' {OIY) and/or conditionally ex thertl�pthazard us small waste or tity v tteator {o I from other sources heI agree to accept the addit additional charges for disposal <br /> L�a3) Thiswasteisfromat , , <br /> in my DIY! CESQG collection tankis solely from DIY and/orCESQG Sources, I have not mixed this waste oil with tiny o <br /> of this waste if the information I have provided about this waste Ez incorrect <br /> (All generators/ customers MAST read the following text and check the associated box ' ) <br /> re .t me kind <br /> in dices the present and futute threat to human life`andthe cn3coon . rni; Or, if I am a small quantity qen ratttt l <br /> <f If l am a targe guantltY generator, l certify that 1 have a program in place toicduce the yr„utYtAand toxicky of WS'Le 9 nt'0100 to the dept e I ha 'i' Y3ett+trttinedt:s f c_onomlcally practicable and that 1 uvr_ <br /> im <br /> rZlar fed the pmrticahlp mrthnd of traarme..nr, storage, or disposal currentlya4at,.,f..e to Ina <br /> have made a good faith effort to minimize my waste generation and select the best waste In method that is availahle to me that I Can afford. <br /> tions of waste and materials <br /> ity to <br /> custorri <br /> t the forgoing <br /> This individual signing in the space set forth below ono tettilon in acco dant pv ith appli sents d ble st to andthat <br /> federal regulathe <br /> tionsh nd dil Cusdtomer shall abide and be b undsbypthe Standard Ter s and CondaCcns on the rc+rsre true and e <br /> as packaged, marked and labeled, are ready for transportation e�~�� Weelli <br /> r� <br /> side of this Service Order. Ile <br /> f Well, e/ <br /> lei t <br /> tt _rif— ell _ <br /> r ' s .Driver Signature' W Date <br /> ., rlel <br /> Ci�ston)er Date Signature <br /> lf <br /> Print Drivers N<1nte <br /> r#irreint Name <br />