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<br /> ENVIRONMENTAL SERVICESTM T N LUTHER KING R B VD � {� TEOE5
<br /> 1300 South Santa Fe Avenue ,y
<br /> Compton,CA 90221 ST0 '�UN CA 952- 64/21/2=3 SCHE U ES OCKT ON, CA 6',"926)400-90,494 (026) -5<
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<br /> have not 'xwaste mi ed an of the described above Ywith any other hazardous waste,the total halide content is LESS than 1,000 m pp ,and the waste does not contain any PCBs.I have`complied with the requirements of the applicable California or Federal Used Oil~
<br /> 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.
<br /> I 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 have provided proper documentation to World Oil Environmental Services to rebut the
<br /> presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect.
<br /> This waste is from a tank which collects used oil from household"do-it-yourself" DIY and/or very small quantity
<br /> Y (DIY) ry q y generator(VSQG)sources.To the best of my knowledge,the only used oil contained in my DIY/VSQG collection tank is solely from DIY and/or VSQG
<br /> sources.I have not mixed this used oil with any other hazardous waste or ushd
<br /> ed oil from other sources.I agree to accept additional charged 1hs for disposal of this waste if the information I have provided about this waste is incorrect.
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<br /> I certifythat 1 have a program in lace p g p to reduce the volume and toxicity of waste generated to the degree I have determined to b
<br /> g e economically practicable and that l have selected the practicable method of treatment,+storage,,or disposal currently available to which minimizes
<br /> I { the present and future threat to human life and the environment.This 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 descriptions of waste and materials are true and
<br /> accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide by the Standard Terms and Conditions on the reverse side of this Service Order,Service Orders with an associated
<br /> hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration of the eManifest program.These fees vary based on Manifest type,Applicable fees will appear on your billing invoice.
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<br /> customer Full Printed Name Cust r6br.,Sighature Date Driver Full Printed Name Driver Signature Date
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<br /> Form#:WOES01-L
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