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4(h Lr 1FOR ACCOUNTING CALL: _ 562-231-1550 1!"If�:,L 111`O AF 10 WORLD OIL ENVIRONMENTAL SERVICES,. H14287 EAST MANNING AVE,PARLIER CA 93648 I IIFI'Y t.L114E#14116 1-559-498-0240 BROAMASF INCA a 1648 E. HAMMER LN. WWW.WORLDOILCORP.COM 1471 SHORE ST o %QN1 IAL Y RILLING3 WO OF T S1'0GKTCrN,CA 952710 TRANSPORTER EPA#CAD028277036 WEST SliGRAMENTO CA 95691 O "`t'1�. Cft:y Cs't1''1 (t.'9t.yl ",;'r-•11�i5 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# c( BILL of LADING/MANIFEST# 1 '/'.?t►/:7,117 CAI-00t 4 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL f USED 0I`L I MIXED OILS I i. k I 0PI1,1 t{,MAKE SURE TO LOCK SIDE HATCH WHEN DONE RAI 011# ) I i .• i r6s�fts "'•s°J T" ! -V OAXON C)Kl,-i I ('411W.ID TOTAL L CASH REC'D: CHECK# 'lcr,: WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: 'Eg1 j`1't' rtVif2G?a ry i LSF .'fIGE;y%:i , IWU MORGAN RD CFRES,CA r3835�'2Ca�11"t47•+8i�7,^9LR43>J3�:iX J DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) { Al)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have complied with the requirements of tth"applicable California used oil 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 x#21 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I have provided proper documentation to world Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges forthe disposal of this waste if the information I have provided about this waste is incorrect E=1#3)This waste is from a tank which collects waste oil from household'do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CFSOG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG collection tank is Soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste orwaste oil from other sources.I agree to accept the additional charges for disposal of thiswaste if the information I have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) O#4)IN am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicityof waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to hum�p,jLfe and the environment;Or,If i am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that Is available to me that 15an ffor f This individual signing in the space set forth,below on behalf of Customer represents and warrants that he/she has the authority to bindustomer,thae forgoing descriptions of waste and materials are true and accurate as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Cudomer shall aXe and be bound by.t a Standard Termsand Conditions on the reverse side of this Service Order. i i r C' tQ r Signature Date / rifer Signature /% -' Date �1— Print Name Print Drivers Nam L