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FOR ACCOUNTING CALL: iNOD(1, 562-231-1550 N24;88777 AF 110 WORLD OIL ENVIRONMENTAL SERVICES- H JIFFY LUBE#1478 14287 EAST MANNING AVE,PARLIER CA 93648 BROADSASE INC p 11W E HAMMER Led _ 1-559-498-0240, 1471 SHORE ST EP MONTHLY BILLING WO 9 OF WWWWORLDOILCORP.COM i rUCKTGN,CA 95210 TRANSPORTER EPA#CAD028277036 WEST SACRAMENTO, CA KAW O i'2W 952-87130 (91 03) 37-5-1155 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES '124 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# i I 11 0201; C, K794439 t. � PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL USED OIL SEHYIGF CA-JARGIE- Vic OSED OIL I MIX--.0 OILS i ALL DRIVEIS MAKE SURE TO.L.UCK SIVE HATCH WHEN DONE BATCH� Cm s Sfreets CW TC)DK DIXCTN,• DKI00152 EXPIRED TOTAL i CASH RECD: CHECK# Ac-caio M1art.,mer. Steve Gatety WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE____ OTHER: DESIGNATEDTSDF: _ ALTERNATETSDF• i,920 4 _ �e,A y �� - J DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) I -1 J I 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 Ile applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal ofthis waste if the information I have provided about this waste is incorrect ON2 I have not mined 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 for the disposal of this :4 waste if the information I have provided about this waste is incorrect O#3)This waste is from a tank which collects waste oil from household"do-it-yoursell"01Y)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESQG collection tank is-soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste If the Information I have a ided about this waste is incorrect ( II generators/customers MUST read the following text and check the associated box.) �Iaw fIama large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable andthat I have ed the practicable method oftreatment,storage,or disposal currently available tome which minimizes the present and future threaIto human lifend the irgnment:Or,ifl am a small quantity generator,made a good faith effort to minimize my waste generation aril select the best waste management method that is available to methal Icanafford. /// 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,th he fotgoJ'p'g 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 Customer shalip ide and be+bound by the Standard Terms and Conditions on the reverse side of this Service Order. ! / Customer Signature Date Dritfer Signature Date 14r—,1 ,Name Print Drivers Name