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FOR SERVICE'CALL: <br /> 1-800-727-2879 SERVICE ORDER <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 WORLD OIL ® No. <br /> ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE' COMPTON,CALIFORNIA 90221 (800)974-4495 EPA#CAD028277036 too/ <br /> Date .,zz Customer# <br /> Customer !Ll Lia '1�i5 EPA# <br /> AddressrF <br /> ^ � PO#_ <br /> City 41 Ct j C '\ State Zip a SIA-1 Commodity <br /> PhoneHalides PPM <br /> Contact Amount <br /> Cash ❑ Check# <br /> Notes: <br /> Waste Disposal Information <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIVMIXED OILS)STATE CODE 2al <br /> ❑ NON-RCRA HAZARDOUS-WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE = <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(AQUEOUS PARTS WASHER SOLUTION)STATE CODE 135 <br /> ®' NON-RCRA HAZARDOUS WASTE,SOLID(OILY PAPER/PLASTIC FILTERS/DEBRIS) STATE CODE 33622 <br /> ❑ OTHER <br /> MANIFEST# f <br /> NEXT SVC DATE DRUM SIZE 5757- QUANTITY # TRUCK NUMBER <br /> DESIGNATED TSDF: - <br /> ❑ WORLD OIL RECYCLING*2000 N.ALAMEDA STREET*COMPTON,CA 90222*CAT080013352-(310)537-7100 <br /> ❑ WORLD OIL ENVIRONMENTAL SERVICES*2549 SCOTT AVENUE*CHICO.CA 95928'CAL000827844*(800)733-9043 <br /> ❑ WORLD OIL ENVIRONMENTAL,SERVICES-CHICO II,LLC*1618 W.5TH STREET*CHICO,CA 95928*CAD980694103*(800)733-9043 <br /> ❑ WORLD OIL ENVIRONMENTAL SERVICES-FORTUNA*200 DINSMORE DRIVE*FORTUNA,CA 95540*CAL930256136*(800)733-9043 <br /> ❑ WORLD OIL ENVIRONMENTAL SERVICES*7300 CHEVRON WAY*DIXON*CA 95620 CAT080012602 (707)693-6008 <br /> Xn` YES-MANAGEMENT,INC.*6500 US HIGHWAY 95*YUMA,AZ 85365*AZR000521146- (928)344-9828 <br /> ❑ RAMOS ENVIRONMENTAL*1515 S.RIVER ROAD*W.SACRAMENTO,CA 95691 *CAD044003556*(916)371-5747 <br /> ❑ WORLD OIL ENVIRONMENTAL SERVICES-CERES*1920 MORGAN RD. *CERES,CA 95358*CAL000393680*(209)541-1825 <br /> ❑ BAKERSFIELD TRANSFER INC.*1620•BRUNDAGE LANE*BAKERSFIELD,CA 93307`CAL000282598*(661)377-0308 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC*14287 MANNING AVE*PARLIER,CA 93648*CAL000102751 *(559)498-0240 <br /> ❑ US ECOLOGY VERNON*5375 SOUTH BOYLE AVENUE*LOS ANGELES,CA 90058' CAN7030993"(323)277-1500 <br /> ❑ ALTERNATE FACILITY <br /> QEN TOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By Mpnkv be4w I hereby md*v Intl: <br /> (Waste oll-g r/customer MUST check ONE of the following three boxes) <br /> O N1)1110,% <br /> n t mbmdla of of wetle deeor bed mVO4* wfto W<netetl jeothwhazapdous wm*.the toW hrlede MlU a LESS thm 1.(XX)F�, .rw111w w:M10[leis not op%jmj a y PGtle.1 Imwco,14*MIwa#1tivl(ItartaYe"natI Lhot0 IIllm W the additiorxllcl,e,pat forItsdwpwWofdwweft m th.,Wuluwxl I II„w,IxovkWj about 0 wasIft w Y1co11ect. <br /> (❑X21 I hs1N not mbled any d Ula waft dmeaaled an i1e m ryw Or-rm"Aed hatarckm waste.UMI total IN"md4wit ke OF"MR IIw1 I.W)14AIk u 1Uw w,ete due Ixx cot111et u PCau.1luwe ar*lerlto1fiMltl ql E"*orMvNM earviose t rebut ttw f—Wxinh waste Wlq ri 1M pgw111x3e1e11atadotM waste.I spree to adopt ftw ak*Ilaid WM*gee kA U dlpxwd,A dile,wnete II On*domxitklt I Ix[ve IMa„xlerl about thea w,Irla k e1c(x reel <br /> (❑x)TINm wast Is lmin A teat Wf"oogscle Waste W from houOPIVId'C"-yoteadr'(pn 1 andtar omiationepy exaav Wrld q mntlly gotmaik r(CESUM flxa.we.k10 w I am of ally tuxw laryle.Ile a*waele oft cantakwl ki my o1Y/cESOG <br /> ooModon link w moldy hun my=sw mmeow I have not whod dtw weete ON WO&W other hetrardouf wast or wast oft tro,n other sounea.t-0 In Io ux.wl 1tw a*Ink.W rI-pes 1_dlpxxall ul 11&WOW.it th.k,Ia.1m11o1[1 tMlwr p,4v**x1 N_a <br /> this watle In klooweeL <br /> (All generators/customers MUST read the following text) <br /> I oedpy that I have a prWm in pwoe to redios the volume&A toXlally d watt gerwalad to the dogrel I have delennkwd to be soonomicaly praotwable a11d UMx I here eek,Iw111to ploe:tbnW*v Il U Wel of <br /> bealrriwlt storage,of tafpoad aela*wallable to num wlUoh wlkrfnbm SM pmaerl&-A kkee Ilaest 1a bO rmn Nle am UM W"omrlent. <br /> This iMMdud e191Nr1g In tlM apmoe mq fotvl below on baheN at OLWmff ar tapremwlt and wwmf t#W tWW*hoe pie wowdty to b*xl Cuatulxx tlw the kw"%P. yAM*I,A waxto wxl nmlorklb w 1RV dxf nccumte m1 Iwj agwF.axvkott ax1 <br /> 1[lbsled,ant an*far hnrportrUm In aoaordmnea atal apP*Mblm W"and%d"NQUIONe(M end that C.LMtartler atoll abide mid be bouexl by t1y StMXfud rawly . <br /> l'wxsMxXM 01 tile reverts aktu of II40 servku or(Iw. <br /> CustornerSlgnmure own Signature Date � <br /> X 1\1 c i . 1- � 1 <br /> Print Name Ptint Drivem Name — -� <br />