|
r r
<br /> '.... .,.:_ .:... PeRM�+'.•9;i.N•. Pf(/rI, rAA oe xi .- s
<br /> WORLD OIL
<br /> CESYHYYYYY.
<br /> ILCOR-..
<br /> WWW.WORLDOILCORP.COM TRANSPORTER EPA#Cloo--H,
<br /> TRANSPORTER EPA#CADOZS Its,
<br /> CUSTOMER♦ PURCHASE ORDEgaROITE I TRU K# CONTACT NAME
<br /> CUSTOMER/ PURCHASE ORDEgI ROUTE# TRUCKf CONTACT NAME ORDER TAKEN By HALIDES
<br /> ORDER TAKEN BY HALIDES )/
<br /> BILL.1 LADII
<br /> REWIRED DATE CUSTOMEREPA.
<br /> XTSERVICE DATE CUSTOMEP EPR# pINw MANIFEST!
<br /> PART# DESCRIPTION
<br /> PARTY DESCRIPTION OCITY UNIT PRICE QTY PN TO LonUNIT PRICE On TOTAL
<br /> !I
<br /> CASH RECD: _ +`
<br /> -_ _
<br /> CASH gEC'D:__ _ CHECK fCHECK! _ TOTAL_ TOTAL WASTE DISPOSAL INFORMATION
<br /> U NON RCRA HAZARDOUS WASTE,LIDU10(U WASTE DISPOAL
<br /> O
<br /> O WASTE DISPOSAL INFOflMA710N NO q R HAZARDOUS WASTE.LIOUIO(ETHYLEED 0NE GLYCIXEDOL SOLUTIONSI
<br /> D NON RCRA HAZARDOUS W STE.LIOUID(USED 014MIXED OILS) 0
<br /> O O RCPq HAZARDOUS STE.LIQUID(E'rHYLENE GLYCOL SOLUTIONS) _
<br /> STATE CODE tZ1 DE GN i sOF: -'-- _ _
<br /> T TE CODE ZZI
<br /> OTHER
<br /> -- - 5 iE CODE
<br /> ALTERNATE
<br /> TSDF STATE CODE_ ALTE NATE TSDF:
<br /> LTE NATE TSDF._
<br /> DRUMS PN.
<br /> --- �
<br /> Y DRUMS: _
<br /> N FACILIT
<br /> M
<br /> Y _. BSC
<br /> BSC NE
<br /> EMPTY DRUMS: EMPT
<br /> DRUMS PG»EflATOq WASTE
<br /> FACILITY:
<br /> CERTIFICATION(PLEASE CHECK T
<br /> GENERATOR WASTE CE'.ATIFICATION(PLEASE CHECK THE APPROPRIATE BOX) HE APPROPRIATE BOX) -
<br /> g,I 'mN(Waste gene (Waste oil generatonbu«slomer MUST
<br /> Oil rator/customer MUST ��..,`w`",'0e, «a« DABDk ONE of the�ollowin ihT
<br /> heck ONE of the 1011OWing three boxes) dim«'°"''""»w•'a.•r„„,,,,,,.,,n,,,,,, x».w .w,r„we,raaN aB boxed) .c..
<br /> �»�°'°n»m�„��'x°.�ao"'0„rww.., mMm,..,,” a"",.a>.,rn...e�,m".� s..,.,,n .w..,",,. »»m,� .oe..,"r m�,a.,.�,� m,.,m.��'"°"'p�am... =I'•wI«m.am:rder�..�'«.
<br /> mF.«, ,...,.,,".Adm.��"., `"°'"•n•nc"W,...,.r., rn�,.»r..„a.m,. .....,.�, O n ,.•...H r.,«,,,«r ,n,.,..»».•m,..,reun,,,.n.a..,...,.,, .a+.,.
<br /> ...,,..«d„".r
<br /> a. ..o..'.r�.�....... .,�, .,.d«. (AI19eDaraMWcu wx,I,,,,,.n«„.N..,a..m.,,nr....,.,•�...,,», ..,,,n.,n«.,«,,.,..,.»....
<br /> (All generators,c rrso� ar °Ouj'"'°"••^,.m•..'«, v°'"°'^»•«",„,,,a o, �fPe Ma MUST read the f011OWln•<m.
<br /> stomers
<br /> MUST mmr.«m.„.a..m,. grNNwnRIPx.+r»F°i0"N,,,,I„,NwlN.mr� 9text
<br /> •»w:'; °^w«'»„«•'» d the fOIIOUo g text ,. »vR..r.,n...
<br /> ., ,`::. n•,,.»..,«, .n. +I.ral.`"rq '��e:n:n'I'.N,N.,.I�,;:"n«;°,:8rn.,°"`"°°°.•„»•°;w,:.w
<br /> WIOAMr 9lgnelure���� �� nrc, "" ,Ines 'fin;eu+am»,,,,,•nM, 4wi#M�'iL"•n•.ror«In.Mw•.mm,yn N..,,.
<br /> DOh/ _/_i .na.emnnnnon
<br /> 41t NeIIy Oliver Signal...
<br /> Date
<br /> ... -.. _ Print�rlver Name
<br /> stn
<br /> etaW061U wtl0oH 9H iUna.)iMp t�IIM _. 11
<br /> �PLy'�dTex�?X¢o: _'AaIAFSgYa -
<br /> _« 018 373 JJK
<br /> „� .. "34JJK W `iarrxKiLw. LA vn ew ER wAr"+o.m..r
<br /> Hr»+ � ssalH srocKrox
<br /> ..,ow»,. wC,eaO aL ENVIgo wsERrxrs
<br /> e p,x wnr•dnxmxwsaeAffev. ,c,•<'O near "«”"""»"""' NCAD8ZiiDHa
<br /> b1KCR8nEL0 TF1NCr'q'.VL aMMNquYaw«.NR•Abr
<br /> WOMD Oq RFCYNNG
<br /> 6X1 A us
<br /> f ':. " 100D NptTNgWAEMSTREIT Ean9N.ro.
<br /> u sari
<br /> mowiaLpD
<br /> r, CAi08G013351
<br /> am>ae•vOw�inr! ,i�a�P+A9 Kwexmaa•w.w N:.da.
<br /> EMERG
<br /> ' "'H'NCR11MrAR000S WASTE UWIJf01ESEL WAtERI O�ery
<br /> EMERGEN[CO IAC CIIEMTPF(. s WATER NCY COMACr CHEMTREC 1800 2<9 aL ,
<br /> UIL WATER ADDIiIONAIF A.,JDES I._ T - '- ,) 1. WATEgORpERASEODO0a3g659'ApD'TOULE AC(',J 2y '1v ,.:
<br /> 1qX 11a+%Jwr,F'Keewen8dxawnsgnen aPNManeauu r.euneena {1;�J, rs •�W++E.OrI'ec[PmKAipx 'E...a P4 Pl.A!'pERSOVAL ,"lUTEC I'eE FQr IPMENI
<br /> nrea rmemwaurad.am •'ewOzoPm•rwralnMa+,rw'raroxs9 wkmrzn muoona crone onN9mmenW rMeg.awom reremenasssrfieo.v""+v EO"'"�KNw u°r"e wu uN f0f1"e�rov Ix v, Az`O�m""`. n�Nazrneeaarore
<br /> e�a'rnrua vvwn mnanup„wrmrA«,nAe+rmzdgeanatlm EAAMnP,.hgmanrdCmunr I��eaponsn .m _ Dmiemaeu.Na nma %me
<br /> «wa zroennnannw aNUi1+INramaragapanety g,«, alellll,em azman euambgenenrwliz wa 0•^°�'ora'Oaan'aP>rmrtyµyrp,uV� vna Xgaq+nM �aPl pyramaz'mr.Q,m�mma r9Nzow'v n p,y,,,yy,'�°�'��
<br /> aznmraw brHNnaOCiR ata
<br /> W rtrynH Sgndure _
<br /> ❑
<br /> '»'a snpm„n ❑--mus n - II) Il It .."""'n°"'H�"w�'°' ^ u a �'�-2.-� wv •a•Ear ❑ ❑ ✓ ral. w,N
<br /> ;
<br /> --
<br /> -----------------
<br /> ,. r.""`".w»P.dP.=d.drvaa', k rIT» Aa.a�ddNaL„.
<br /> N�N.a, aN
<br /> ❑% ❑,ce ❑ w, 1 a ❑ ❑,aq ❑F..
<br /> �r „a4 �I ❑Pa� M ❑rMgA� rNM •r«Mrm ❑F aq BE ❑
<br /> "row b UN.mn., ; ' a ,o q,d
<br /> .re�,
<br /> 1e.xR+m„xOw Awn gNH+nn
<br /> .aazx-asr.«abmlenwv
<br /> Ne+mWx•I..menwruulyd'xvei'H ara,amzl n �a. M/�q,�, Nn':,rMm„rmn,,...,a4zM
<br /> 1 �N V"I N�,�•�.��a�.nln�ta�retr�,PKma,
<br /> N.oPrepL,r,•'ava,N,aOP*R,.uMReond N�-a�'�H,.d
<br /> ,_ � '«MdNue°"'nr+"n«ur•aWwm•n � I '^^M4m^'•e%i1•^'+NN+r«
<br /> ImamW.wlq.eM 4i ) 1 ( ,
<br /> DESIGNATED FACILITY TO GENERATORDESIGNATED F
<br /> AGILITY TO GENERATOR
<br />
|