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r'Url MUUUU7V 111 VU UHLL. 562-231-1550 14VOC1411D i J2518543 l AF 110 WORLD OIL ENVIRONMENTAL SERVICES, 5 7300 CHEVRON WAY,DIXON CA 95620 I" ,IIFFY 1_0FIE#1478 1-800-727-2879 BROADISASE= INC ,P, 1ra48 E HAMMIER LN WWW.WORLDOILCORP.COM 1411 SHORE 5T E MONTHLY BILLING Wo &r1F T ST0CKTOPJ,CA 95210 TRANSPORTER EPA#CAD028277036 WEST SACRAMENTO, CA 95691 Q (209) 862.6,1161 (916) 375-1155 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES - 5 k UTir IZd LfOZ`� SCHE t7ULEC1 i1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# ;0/2016 1 1 CAL000204439 ` C-)( C� Z�� r-I 1t:111 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL USED OIL SERVIC F CHARGE 1 _ W".) USED 0711-/MIXr-O OILS 485 1 L'Df lt1[= S MAKe SURE TO LOCK IDE HATCH WHEN DC.NE BATCH ..M t.r a�S Streets 0W'T0 DK DIX0N- 1)K100152 EXPIRED TOTAL CASH RECD: CHECK# Acaalmt Mana r.Steve Gaggy 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: ASPJ ON LSE ES Q -- ' DRUMS PILI: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby certify that: �c (Waste oil generator/customer MUST check ONE of the following three boxes) A 41)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 the applicable California used oil management regulations to determine this is true.1 agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect =3#2]have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,OD0 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 waste if tie information I have provided about this waste is incorrect k O#3)This waste is from a tank which collects waste oil from household"do-it-yourselr(DIY)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 provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) :XFLtl If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity ofwaste 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 human life 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 I can afford. 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 as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse side of this Service Order. C6er,$jgnatuj`- Date Driver nature I }� Date �'( Print Names fi Print Drivers Name