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FOR SERVICE GALL
<br /> S AWlORDER
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<br /> 1400 727;2879 ' * :`SERVICE ORDER NO
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<br /> C115TC?NIER# .Pt1RCHASE 7 RU,CfC ,':CC?t+lTAGT tVAtVIE QRpi*R TAKEN BY '� .,HALIDES
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<br /> NON RCRA HAZARdOUS WASTE,LIQUID'{USED OIL/M)Xl D OILS) STATE"CODE21 �
<br /> NON RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
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<br /> ' DESIGNATEDiTSDF R ft 1RONMM � � ,,9 , f *CeR B�= { } 1- MY MODO
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<br /> DRUNIS'P%U EMPTY DRUMS LLw FACIL#TY BSC
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<br /> GENERATOR WASTE CERTIF1CATlON.(PLEASE CHE(KTHE APPROPRIATE SOX)
<br /> By signing below I hereby certify that.
<br /> �1Naste oi!generator'/customer MUST cheek ONE of the following three boxes)
<br /> #t)Ihavenotmixetlanyofttiewaste�
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<br /> described aboJe With ahy;other Aaz3rdoas Wasfe the total halide coit3ent.is LES5 than 1,000 ppm end fire waste d'o`es not`contairi any PCBs.I have torhplied with the requtremen'is of
<br /> the applicable California used oil management regulations to determine this is true.I agree to accept theadditional charges for the disposal of this waste if the information I have provided about this waste is incorrect'
<br /> O#21 have not mixed any of the waste described above with any other hazardous waste;the'fotal halide contends GREATER than 1,000 ppm,and the Wasterdoes not contain any PCBs.I
<br /> have provided proper documentat'on to World Oil Environmental Services to rebut thepre umptiorJthatthiswrite was mixed with other hazardoys waste.i agree,to accept the additional charges for the disposal of this
<br /> waste if the ihformattoo I have proviiied 44,6t this waste is incArdect
<br /> and o cond'tlo al'` tem t small uanti enerator,cESQG sources:To the best of m knowledge,the only wasteoil`contained
<br /> O#3)This waste is from a tank which collectswaste'oilf ihihousehold°do=lt-yourself(DIY) 1 r i n lye ,p , quantity ( ) y. ed9, Y
<br /> in my DIY/.CESQG coliectioKtank issoley from RIYand/or'CESQG sources I have not intxed this Waste oil with any o`ther'hazaidouswaste ortvaste oil from other sources.I agree to acceptthe additional charge's for dispo al
<br /> of this waste if the information I have provided about this waste is incorrect
<br /> (ARgenerators/customers MUST read the following text and check the associated bok.) '.
<br /> #4) i am a large quantity generator, certify that i have a program in place to reduce the volume and toxicity of waste generated to the degree t have determined to be economically practicab and�thai i have.
<br /> ed the practicable method of treatment;§torage,'or disposal curr`entlyavallabie to nie which minimizes thepiesent6nd futtiiethteatto'liuman'life a ' environment Or,if I am a s quantity generator I
<br /> have made a good faith effortto minimizemywaste generation and select the best`waste management method that is available to me tliatl eah`aff x
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<br /> This individual signing in the space set forth below on behalf of Customer represents and warrants that he/shehas the authority to bind Cust er,that the going descri s of waste and materials are true and accurate '
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<br /> as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal,reguiations,and that Custo r shall abid d be boun the Standard Terms and Conditions on reverse '.
<br /> side of this service Order. '
<br /> C stonier Si nature Date river/Signature / ate` `
<br /> Print NamePr)n rivers Name J�
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