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FOR SERVICECALL:
<br /> SERVICE ORDER
<br /> Af,ON OFFICE ' 1 , FORM NO . WOES00I (8/18)
<br /> 'AI VASRURY,:, ENVARONMENTAL SERVICES, DBA
<br /> 11 =800.7247.28719r , i SERVICE oRDEo.
<br /> FOR ACC{OUNT�ING CALL : t•t ,s „ 1r~t
<br /> 562-2314550woRLD 01L
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<br /> ENVIRONMENTAL SERVICES x
<br /> H 7300 CHEVRON. WAY, DIXON , CA 95620
<br /> -800-727-2879
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<br /> P + .{ i 6 � ➢ f �( r < ty WWW:WORLDOILCORPICOMIF
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<br /> TRANSPORTER EPA # CAD028277036
<br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN iSY HALIDES
<br /> DATE REQUIREb DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # RILL of LADING/ MANIFEST #
<br /> 55
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<br /> PART . DESCRIPTION QTY -1 UNIT PRICE QTY P/U ` TOTAL
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<br /> NON=RCRA, HAZARDOUS WASTE, , LIQUID (UStD :OIVMIXED OILS) STATE CODE 221
<br /> NONaRCRA :HAZARDOUS WASTE; LIQUID (ETHYLENE GLYCOL SOLUTIONS)
<br /> OTHER : STATE CODE
<br /> DESIGNATED TSDF :
<br /> ALTERNATE TSDF :
<br /> ,. EMPTY DRUMS , FACILITY,• RSC
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<br /> ttli, It ifivI0 Alma
<br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX)
<br /> By signing below I hereby certify that:
<br /> {Waste oil generator/customer MUST check ONE -of the following three voxes)
<br /> 0 #1) 1 have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS then 1 ,000 ppm, and the waste does.not contain any PCDs. I have
<br /> complied with the requirements of the applicable California used oil management regulations to determine this is true. I agree to accept the additional charges for the disposal of this waste It
<br /> the Information I have provided about this waste is Incorrect
<br /> (] #21 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. l agree to accept the additional
<br /> charges for the disposal of this waste If the information 1 have provided about this waste Is Incorrect
<br /> Q /f3) This waste is from a tank which collects waste oil from household "do-it-yourself" (DIY)and/or conditionally exempt small quantity generator (CEI sources. To the best of my
<br /> knowledge, the only waste oil contained in my DIY/ CESQG collection tank Is soley from DIYand/of CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste oil
<br /> from other sources. I agree to accept the additional charges for disposal of this waste It the information I have provided about this waste Is Incorrect
<br /> (All generators/ customers MUST read the following text
<br /> I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the
<br /> practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment.
<br /> This individual signing In the space set forth below on behalf of customeerepresents and warrants that he/she has the authority to bind customer, that the forgoing descriptions of waste
<br /> and materials are true and accurate as packaged, marked, and labeled;are' ready for transportation In accordance with applicable state and federal regulations, and that customer shall abide
<br /> by the Standard Terms and Conditions on the reverse side of this Service Order. y
<br /> Service Orders with an associated hazardous waste manifest (either site specific or consolidated) are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration
<br /> of the eManifest program. These fees vary based on Manifest type. Applicable fees Will appear on your billing Invoice. /
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<br /> Crus mer Slgnaure Date Driver Sign urea ' l Date.
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