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FOR SERVICE CALL: SBRVICE ORDER FORM NO. WOES004-B(8x13) DIXON OFFICE SBU Y ENVII 014M�NTAL SERVICES, DBA SERVICE ORDER NO.. 1-800-727-2879 FOR ACCOUNTING CALL; 562-231-1550 (W',�)WORLDOIL ENVI-RONMENTAL SERVICES" 5 7300 CHEVRbN WAY.DIXON,CA 95620 H RJF'W 0 PI'f#E DC�PT 1-800-727-2879 Em.;!a , rxxrklyd WWVIrcWORLDOILCORP.00 1 142 S W'{ ' 4 D ipoN953 T NSPORTER EPA#C-AD028277036 r CUST,OMEFjs#; PURQHASE ORDER 0 . ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY 'HALIDES DATE REQUIRED. 01119DATE!ENTERWL. NEXT SERVICE DATE COSTUMER EPA k. BILL of LADINGY MANIFEST4 Z C fAL1�(lE "'43 f QTY. UNII.MCt QTY _ZU'. .OJSOR �AL FILTFIR-DULM FtEPLA MWT W-1 Gi4ARGE 1 $0170 t 0".) F TOTAL. CASH REC'D:. CHECK#. 6T WASTE DISPOSAL.INFMATION NON-RCRA.flAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STAVE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE'GLYCOL SOLUTIONS) STATE CODE OTHER:_ 1X*1 R0R4 A1ARr9=.WASTIL 8WD iFIL'I MS CtAT IMNGOIL STATE 4:,GD9.223 Y DESIONALEDT$DF: Its, - ALTERNATi�TSDF: _---- -- —AW*ia�matl or Sim.S&T DRUMS P/U. --� - EMPTY DRUMS:-_. __. FACILITY BSC --- i GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing bslotiw Thereby cer"that: (Waste oil generator/customer MUST check ONE of the Tollowing three boxes) i,]#i)I have not mixed any of me waste described above with any other hemrdous waste.the total halide content Is LESS than 1,0011 ppm,and Me wMI?does not contain any PCBs.I have com plletl wilt-flfa nquhemenU 1 the spp�cahle 6fh-Mrnk used all manegammN regulations to dstermwne Ehis 1.fn,iL l agree to accept tim add MmW charges far the disposal of this waste if the inkmwdan I hers p wli id Ni6ou1 Mils w"isjwcl read 1'21 have not mixed any of thawaste described above with any other hatmrdoue worts,the total halide contain Is QREATFR ih+n 1,000 ppm,and the waste does not contain arty PCBs I Wer documanle ion to World Oil Environmental , Km provided pr Services to rebut the presumption Chet alfa waste was teed with ot)tar hamrdous wssta.I agree tc accept t rel�eddkkmW charges for the disposal of this warts If the iniormatkm I have provided about this waste Is incorrect s3)1hls waw(s'Tmm a tank which collects waste oil from household"do-Hjyouie lP�(DIY)andforcondldeaally exempt small quenitty generalar(CESOO).durc es.To the best of my k.rirdgt the oiiywaala oll'cait•Ined In my DIY CE!f0G col lecld n tank is soleytrom DIY WxVor CESW so ran.l hens not mbted this ate oll whh any ober h mkm-dws waste or waata all from other sourotfl apeer to wxopllha adaW onel charges for dispoml of this wine B the Inlomration I haus provided about this wast*is incorrect (All generators/customers MUST read the following text I cam,"I have a program In Plsoa to mdua s the volume and toxlrity of waste generated to the dagme I have determined to be economically practicable and"I have selected the practicable raslbad of trsaenrenl,storage,or disposal currently available tome wW_h minknizes the putt and future threat to human Itie and the smtironmenL This individual signing In*space,eel lorth:below on behalf of customer represents end warrants"he/she has the authority to bind euetomer,that 8N.forgol., description of waste and metiMils see true and accurele as.packagsd,marked,and lobeled,are ready for tre•strarardan In accordance with eppllcable stale and ted repulatlbns,a that customer shall a6kle by the StarWmrd 1r9ms and Condhlons an the reverse skfe of this Service Order Service with en associated hazardous waste maadfmt(Wthw aIle spechlc or cansolklated}ore wtt�t to an EPA Fee Thera fees raver flee EPA peas Mrpugh ire and administration of the sy.njie�#pryp7am Thess'fees vary basad on Monlieirt type.ApQi=lees will appesr an year blfibrq.invoke. Cush mer Signature Date Driver Sighature Date 5 Print Name PrIhtDriver.Name.