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FOR SERVICE CALL: <br />1 ARLIER <br />559-498-0240 WO <br />FORACCOUNTINGCALL: WODIY <br />562-231-1550 k\� <br />PEP E10Y0#x711 <br />49877 WEST LANE <br />D STOCKTON,CA 95210 <br />0 (209) 9521222 <br />ENVIRONMENTALSHURY D: <br />haw <br />4287 EASTMANNING AVE, PARLIER CA 93648 <br />1-559-498-0240 <br />W W W WORLDOILCORRCOM <br />TRANSPORTER EPA # CAD028277036 <br />FORM NO. WOES004-D (1/17) <br />SERVICE ORDER NO. <br />N2384415 <br />THE EC GROUP <br />201 E, ORCHARD ST <br />HAMMONTON, NJ 08037 <br />(ban) 334-3794 <br />CUSTOMER# <br />PEP359 <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br />Oust We <br />PURCHASEORDER# <br />ROUTEit RUCK# <br />124 <br />CONTACTNAME <br />SCHEDULED4 <br />ORDER TAKEN BY <br />HALIDES <br />DATE REQUIRED <br />DATE ENTERED <br />NEXTSER ICE DATE <br />CUSTOMER EPA # <br />BILL of LADING/MANIFEST # <br />6/13/2017 <br />8/13/2017 <br />CAD981662844 <br />PART# <br />DESCRIPTION <br />QTY <br />UNITPRICE <br />QTYP/U <br />TOTAL <br />WO <br />WOSC <br />BATCH # <br />Cr4s <br />CASHREC'D; <br />USED OIL/ MIXED OILS <br />USED OIL SERVICE CHARGE <br />Streets; <br />CHECK # <br />q <br />TOTAL <br />/ <br />NON-RCRA <br />NON-RCRA <br />OTHER: <br />WASTE DISPOSAL INFORMATION <br />HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) <br />HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />STATE CODE 221 <br />STATE CODE_ <br />DESIGNATEDTSDF:A,y811Rj',;_NVIRONMFNrAI 5FRVICF.&.GE@ES,I620 MOR[-0AN kT7,HERE r,R fttl <br />ALTERNATETSDF: <br />gBQg)5gt.lgzr,;_��q�g� <br />DRUMS P/U: <br />EMPTY DRUMS: FACILITY: BSC <br />below I hereby cerH(y ihab <br />(Waste oil generator/customer MUST check ONE ofthe following three boxes) <br />0111have not mixed <br />anse cm anadescribedabove with any otherhazardous- I agretfalaihalidecontentis LESSthan I,the ppm,andthewtedoesnot mnatioanyave p1havecamp0edwithshes inWrrect sof <br />the appiiable California used oil management regulations m determine this is [rue.l agree m accept the additional charges fin -the disposal of this Waste ifthe information I have provided about this waste Is incorrect <br />421 have not mixed any of the waste described above with any other hazardous waste, the tool halide content is GREATER than 1,000 ppm, and the waste does not contain any PCits.I <br />have provided proper documentation to World Oil Environmental Services be rebutthe presumptlon not this waste was mixed with otherhazardous waste. i agree to accept the additional charges for the disposal of this <br />waste If the Information I have provided about this waste Is incorrect <br />E-1131 This waste is from a tank which collects waste oil from household'dodf-yourself' IDIY}and/or conditionally exempt shall quantity generator (CESQG)sources.To the best ofmy knowledge, the only waste oil contained <br />In my DIY/CESgG collection lank I5 sofey from DIY and/or C¢SQG sources.) have not mixed this waste oil with any other hazardous waste or waste oil ham other <br />sourceslagreeto accept the additional charges lordisposal <br />of this waste it the lnformationilhave provided about thkwas[e is Incorrect <br />(All generators/ customers MUST read the following text and check the associated box.) <br />avclmfi am a large quantity generator, I cefdry that i have program in place to reduce the volume and toxicity of waste generated to the degree I have determined to beemnomicallypmcGcable and that I have <br />d the practicable method of treatment, garage, or disposal currently available tome which minimizes the present and future threat to human life and the environment; Dr, if I am a small quantity generator, I <br />sredo a good faith effort to minimize my waste generation and select the bestwaste management method that is avallable tome that l can afford. <br />This Individual signing In the space set forth below on behalf of Customer represents and warrants that be/she has the authority to bind Customer, that the forgoing descriptions of waste and materials are true and accurate <br />as packaged, marked and labeled, are ready for transportation in accordance with applicable state and federal regulatons, and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br />side of this Ser Ic or/ld <br />Costo r Slynature Date Driver- <br />1�.�-11� <br />Print Name Print Drivers Name <br />