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<br />1-800-7527 879 a R. 01 .• e
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<br />PURCHASE ORDER € ROUTS: # E TRUCK
<br />TE REQUE,_ DATE ENTERED
<br />PART'# DESCRIPTION I QTY
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<br />GENERATOR WASTE CERTIrICATION (PLEASE CHECK APPFIOP�-flATF B0%X)
<br />By signing heiow t her2oy certity that
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<br />(Waste oil generator/custorner MUST check ONE of 4Ahe o"Ll %-Vi iq
<br />ll T -I f have rLoi lanv Gt the wastes de'C'f P.S1 at cvr volt" a �;� other SraX++ Cir r1G'i/ ste, the tni31 'ialltic coni e'tt i LEI.:,--
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<br />cclnplied wifh the regairenients of the appkcrlble CII'lornla used al min agerner,t regulatmrw, to defr,r a Plrls ;: ti,;e>.'<3
<br />f; -,e informalrfon i hasp jHnvidaCS abeyut this wlesta Is incorrect
<br />i_..n =2 1 have not rrdxed any o' the waste deseriued above with any other 1',e t0Ma' haSide conly rt ',o ONE ..:: ,;it? 9-)j y ::-.e
<br />have, provided proper documentation to Vyerld Oil Environt➢1£3livl SerilaC£'S 90 rehut the p k. u...S�!i6 iT'hal Ifils :a s]t�: as l f.., t"th c.-.i.e I nz� .. ,.,. :;1 .....,..-.
<br />charges fol' Phe diCpaSa€ w this :•.°BSta if the inPormallon i have p1'oV€deft nhoul this w251:e Is si]aarrgnr
<br />:i3) This Waste is tram a lank which C01tects waste oil from { cf 8eh Clld of -!C o, cont tjon- (1: L" X£mpt T.�-_� J Il i, 11 -'f
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<br />know3e[Ige, ilia orriy waste oit ct3ntainECt in lily DIVY CU: QG rollvctlon tank is soleyfrnlr:.r'ilY a;:d1'cr CESCIG
<br />f urn otn@r sources. P agree to arced i the addit7oria, cnargns for dispof an€ of lhls vwvte it thy; infer luon € h w' pr'9VIded a€.:OUr ?'riFi was?�- ".- irxCor!'sat
<br />(till generators/ customfil MUST ril th gollowlin text
<br />7 cell ,hat I have 2 program eft piae:e La MdLIee thr: Votaitle and toxicity of waste gcrierat'd 10 the dewec
<br />oractiCnble, t9 eib--c of treatment, storage. Cr disposal currently ava4ka le to M{ . Lvilich mi'mmizes Ple. PYeserlt'f c' r. -it --E' °-hr("at Ro huma-:Q ano thecn'clr'_"'n5
<br />Tills end•, aiei€sat aiyning in the space set farlh he€aw on pelrplt of customer reprEsews art w�f tant'.'- Thal e e Sl i'.!F The 10 c s, t �1
<br />elld materiais Bre true and accurate as packtigE:rlr marked. and }8bei8q. arC Cmnd k for vansnoriat,on ir) accoidi'f Sce, "' Ili
<br />by the Standard Terms and Conditions, of) the reverse node of this Service C;rder.
<br />aervf:ce Orders -.6th an essocialed :;azardaus; waste manifest feither site spe('Ac oY c[tni o€idat d) are :,.]Feet to a§ p",, Fir-. !N'S- f es cc cLr- Ppi- �, .:: .I: 'j,
<br />c# the &&ani§es! pr'oyrom. These fees vary based on Mal ype. Appflcsible [eels ,y=.G appear on your i;;tEi+�. _i ifyVolce.
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<br />Customer Signature � Date ale
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<br />Print Name Prim Driver illame
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