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-•. . a—"vinvrVIVICIVIHL ,tHVICES, DBA SERVICE ORDER NO. <br /> AOR ACCOUNTING CALL: Inc /c�C <br /> 31-1550 <br /> LWORLDOIL <br /> y ENVIRONMENTAL SERVICEST. <br /> ASS <br /> ' TCCKTONaC.AVENCaEFk`s C)C:IA I ICJN 00 CHEVRON WAY, DIXON, CA 95620 <br /> 1240 NAVY OR � aoo 727-2a79 WM (?f= SACRAMENTO NI<V�tU� <br /> 5 MONTHLY Wo WWW.WORLDOILCORP.COM PO BOX 4745 <br /> :STOI-KION. C A 9520ti TRANSPORTER EPA# CAD028277036 <br /> ' (09) 4(X1391:2 PORTLAND, OR 97208 <br /> (9161294-4035 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> MIJSTCti[I'TAIM I <br /> 210 Z <br /> ATE REQUIRED <br /> DATE ENTERED NEXT SERVICE DATE CUSTOMER <br /> /�EPA <br /> y# BILL o+•f�/LADING/MANIFEST#)j <br /> 'Ji <br /> PART# DESCRIPTION <br /> Pi- QTY UNIT PRICE QTY P/U TOTAL <br /> fJFCa; RARER I ICER DRUM <br /> OIL FILTER (_'DRUM REPLACEMENT- NO CHARGE <br /> OfilLr `', 0NL. P1tJ 8,HAZ p/U -U►E U&ako5 FOR C.DIY-i,ANKANJEIJt�+< 209460 }'a ECtlkt ` : NC;FLfCA MAO <br /> AftdELah=. _ '"UM.COM 1 9LANKET f-kD 21141 10fl, ;,tl EATGI #...�.. TOTAL <br /> RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: &?Ari F 5�eu In(!L)II y pnpporpi AsTlf,4It TF:i;4.S I <br /> DESIGNATED TSDF: +1.,:fWfidAEl+1fL! T< I�dC„ 6;104 I,US hilt:a# .Al�,�5. ` }lul, !k 8,365 <br /> ALTERNATE TSDF: <br /> P U REG OIL- LIAR; 13/U RE �UEST R: AME�,QiN>A4LvWM. GOM Aca=wlt Manager: S-aMIUCI Read <br /> IUMS P/U , EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> #1)1 have not mixed any of the wast 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 <br /> mhave pro <br /> plied with information requirements applicable <br /> about this Iwaste is California <br /> fincorrect used oil management regulations to determine this is true.1 agree to accept the additional charges for the disposal of this waste if <br /> #2 1 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 /> ve 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 /> arges for the disposal of this waste if the information I have provided about this waste Is Incorrect <br /> wledhis the waste is from aY tank <br /> il which <br /> i contained imy collects <br /> li waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> 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 <br /> 9 <br /> im 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 <br /> (ADI generators/customers MUST read the following <br /> g g text <br /> ertify that I have a program in place to reduce the volume and toxicityof waste generated to the degree I have determined to be economically practicable and that I have selected the <br /> acticable method of treatment,storage,or disposal currently available to me which minimizes the resent and future threat to human life and the environment. <br /> its 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 <br /> ..Late are true and accurate as packaged,marked,and labeled,are read for transportation In accordance with a g descriptions <br /> tandard Terms and Conditions on the reverse side of this Service Order. pplicable state and federal re ptionS of waste <br /> regulations,and that customer shall abide <br /> '_-.!e Orders with an associated hazardous waste manifest(either site specific or consolidated are subject to an EPA Fee. <br /> the eManifest program. These fees vary based on Manifest t Applicable f�Will appear n our billing These fees cover the EPA <br /> y g invoice. <br /> pass-through fee and administration <br /> :ustomer Signature Date <br /> Brie ign <br /> ature Date <br /> Irint Name <br /> --- - o- - Print n.:..__ .. <br />