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SERVICE ORDER FORM NO WOES004-13(6718) O Q <br /> N FOR SERVICE CALL: SERVICE ORDER NO- <br /> (/) DIXON OFFICE ASBtJRY ENVIRONMENTAL SERVICES,DBA N <br /> N 1-800.727-2879 y O W 00 -4 <br /> FOR ACCOUNTING CALL: OWORLD OIL � * N O m <br /> 562-231-1550 N <br /> M ENVIRONMENTAL SERVICES— <br /> = FIRECD 3 <br /> � s �11 QJ <br /> 7360 CHE=VRON WAY.DIXON,GA 95820 QUEST RESOURCE <br /> � _r- ��) <br /> 1-800-727-2879 <br /> " FIRESTONE 00215746 <br /> WWW.WORLDOILCORP.COM 348i PLANO PARKWAY {n N <br /> E 720 E-HAMMER LANE <br /> TRANSPORTER EPA#CA0428277036 THE COLONY,TX 77056 <br /> OilD <br /> T STOCKTON,CA 95210 (972)484-0004 Q- <br /> ° (20g)g51-2403 m <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> :EFt 85 7 k TRACY arodriquetz _ m <br /> ISi61' p <br /> DATE REO FIRED DATE ENTERED ` NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINGI MANIFEST# Cl) <br /> 1131i?O2� CALGUG3fi8211 13 11 Z o <br /> �1 t � <br /> QTY UNIT PRICE CITY PIU TOTAL O <br /> PART# DESCRIPTION 1 � <br /> AERO-` WASH_,AER(':. LS 55 GL DR <br /> 55-Ofr 55 CALLOW OIT DRUM(RECONDITIONED) f ccs1 <br /> IV <br /> O <br /> y M <br /> BATCH TOTAL R� '` <br /> fN <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RC RA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: Ac Int Mnnn Samad 9 <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: BSC yy r <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) 01 <br /> By signing below I hereby certify that: <br /> (Waste oil generatorlcustomer MUST check ONE of the following three boxes) <br /> ❑717)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 me waste does not he disposal <br /> any PCBs-I have <br /> compiled with the requirements of the applicable Calltomia used oil management regulations to determine this is true-I agree to aczepl the additional charges IC <br /> r the disposal of this waste if — <br /> the information 1 have provided about this waste Is incorrect <br /> r L7 a2[have not mixed 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 <br /> 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 <br /> charges for the disposal of this waste it the Information I have provided about this waste is incorrect <br /> entity M anwor <br /> k0#3This Waste is now,edge,the only waste oil contained iin my DlY1iCESOG conecE on tankdis s ey fromDIDyl a)ndlor CESOGIts sources.I have not have mixed this t small qug waste oil with aenerator oyiother hazardous wastte or of oilI have provided about this waste}s incorrect <br /> from other sources.I agree to accept the additional charges for disposal of this waste If the information <br /> I (All generators/customers MUST read the following text <br /> p the y prat t <br /> Ti practicablecertify tI havemethod aoprogramf treatment,place <br /> or disposal currently available to me which minimizes the present and ree I have future threat at to human life the environment /have selected e <br /> tions Of Waste <br /> ar that <br /> by This and materials individual siq rue ain nd a space set <br /> pa packaged,man called f customer <br /> ost tlmarerreardy forst transportation in accordanceshe with appticaj1horithle sthe at tato iledand lade alfregulatinnhat the s anti that customer shall abide <br /> Sf by the Standard Terms and Conccurditlons on the reverse side of this Service Order. <br /> ofare <br /> Service Orders with an m$sThesetha�rdous waste manifest ees ovary based on Manifest types site Applicable wl I appeal on your hill nig;anEPA <br /> fee.Thesekleeser EPA pass-throughrid administrallon <br /> of the eManifestp r �� 017Aa F+ ery�l Date <br /> Customer Signature / ! Date 0 <br /> o m <br /> ! n <br /> Print Driver Name o <br /> r v n <br /> Print Name <br /> C v <br /> (D - ���r---rte` - <br /> Print river Name <br /> w Print Name CD <br /> CD <br /> 00 <br />