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Mouvn s err v u wrrm"fir._s vr.r r r rvr_a5 .....-. t-uhivi 11ju.VVVC000e_t5 t0/10) FOR SERVICE CALL: _ DIXON 1-800-727---p 7—¢, FOR '�ARGr �IIIN 9097700 WORLD a 7300 CHEVRON WAY DIXON,CALIFORNIA 95620 • (800)727-2879 EPA#CAD028277036 Dat e--r�1�—+.,� Customer# 0 Customer 2!11 0 0 I• EPA# L '3 `7 E�S Add rens -(n( D h 2 G y PO# �— City 5tate _Zip Commodity�1S Halides PPM Phone �[�C Contact dl Amount Cash ❑ Check# Notes: Waste Disposal Information ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 22 V"NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE I'33 ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(OILY WATER)STATE CODE 135 ❑ OTHF�Fi MANIFEST# .� NEXT SVC DATE DRUM SIZE QUANTITY 3D TRUCK NUMBER�DC�{ DESIGNATED TSDF: ❑ WORLD OIL RECYCLING*2000 N.ALAMEDA STREET*COMPTON,CA 90222*CAT080013352*(310)537-7100 ❑ WORLD OIL ENVIROMENTAL SERVICES*2549 SCOTT AVENUE*CHICO,CA 95928*CAL000827844*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO II,LLC*1618 W.5TH STREET'CHICO,CA 95928*CAD980694103*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA*200 DINSMORE DRIVE*FORTUNA,CA 95540*CAL930256136*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES*7300 CHEVRON WAY*DIXON,CA 95620*CAT080012602*(707)693-6008 ❑ YES MANAGEMENT,INC.6500 US HIGHWAY 95,YUMA,AZ 85365*AZR000521146*(928)344-9828 ❑/ RAMOS ENVIROMENTAL*1515 S.RIVER ROAD*W.SACRAMENTO,CA 95691 *CAD044003556*(916)371-5747 WORLD OIL ENVIROMENTAL SERVICES*1920 MORGAN RD,STE AES-"CERES,CA 95358*CAL000393680*(209)541-1825 ❑ BAKERSFIELD TRANSFER INC.*1620 BRUNDAGE LANE*BAKERSFIELD,CA 93307*CAL000282598*(661)377-0308 ❑ WORLD OIL-SAN JOAQUIN,LLC*14287 E.MANNING AVE*PARLIER,CA 93648*CAL000102751 *(559)498-0240 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) (❑111)1 have not mixed any of the waste described on the service order noted 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 compiled with the requirements of the applicable California used all 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. (❑112)1 have not mixed any of the waste described on the service order noted 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 Word 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 it the Information I have provided about this waste is Incorrect. (❑113)This waste Is from a tank which collects waste oil from household"do-It-yourself'(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 lank is solely from DIY/CESQG sources.I have not mixed this waste ell with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of thls waste If the Information I have provided about this waste Is incorrect. (All generators/customers MUST read the following text) I certify that 1 have a program In place to reduce the volume and toxicity of 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 human life and the environment. This individual signing In the spae sal 104 below an behalf of Customer represents and warrants that he/she has the authority to bind Customer,[het the forgoing description of waste and materials are true and accurate as packaged,marked and labeled,are ready for WgKfoorlrtl i��Ih 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. q I� Custa Signature Date Driver ure Date rLill. c7c_ccrL Pri pme Print Drivers Name