|
FOt7 SERVICE D-11 . ._. '!..,._ (�;:I i�''�:h =GFiivi
<br /> , ., i0.1iiE:C—� 3ia
<br /> '
<br /> DIXON OFFICE SERVICES, DBA EVORic- RDER ��j
<br /> 1-800-727-2579 _rN27729
<br /> FOR j
<br /> 562-231-1650FiTIiJCi CALI_: WWO R ® O I� --_-
<br /> S I f'ii=.i l,,.... .CA 96620?f i!•;t%:rti�- '4 ON
<br /> IL TEC OF CALIFORNIA -LOUIS=—AVE . .
<br /> 2050 E LOUISE AVE 2050 E LOUISE AVE
<br /> Q
<br /> WV✓`N.WORLDOILCOFIRCOM
<br /> 1) LATHROP,CA 95330 rRANSPottreR EPA cAD028277036 LATHROP, CA 95330
<br /> T (209) 858.4110 (209)858-4110
<br /> . Y
<br /> CUSTOMER 4 PURCHASE ORDER N ROUTE# - TRUCK#,' COT NTACT NAME ORDER TAKEN BY HALIDES
<br /> �ao/y
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST#
<br /> f/7120 19 11172019 L;ALJUU0415480
<br /> MPT 4 11 OWTUNAPIP G NN FIL4FaRS QTJ UNqdME QTY PN JQTk
<br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 4 $0:00 $0.00
<br /> BATCH
<br /> TOTAL
<br /> CASH RECD: CHECK s____-_
<br /> WASTE DISPOSAL INFORMATION
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID (USED OIUMIXED OILS) STATE CODE 221
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) $TATE CODE_
<br /> OTHER: NON-RCRA HAZARDOUS WASTE.SOLID(FILTERS CONTAINING OIL)STATE CODE 223
<br /> DESIGNATEDTSDF:
<br /> PUMA'I m (:
<br /> cue, E i3tF1 s1'.YUIY/ .JCf$3388 �BBa��
<br /> A(,�'ERNgTE TSDF: �._. -
<br /> CESS S7Bel5: ------------------- �fYllifBneger eS m—Reaa
<br /> DRUMS P/U EMPTY DRUMS:_______..-, FACILITY:._..____ BSG
<br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX)
<br /> By signing below 1 hereby carlify that:
<br /> (Waste oil generator/Customer MUST check.ONE of the following three boxes)
<br /> D atilt have not mixed any of the waste described nbova erilh any oiher:,;u::rJovs este,tilt th at h-1100 content is LESS than 1,000 ppm,and the met.dans not eentela any PCs..I I, ..
<br /> complied with the requirements of the applicable Culifo:ala used o!!a:::na ;+11.111 regulations IQ dolermino tide Is true-1 agroo to accept Me additional charges for lhodisp-ml 0111114:vast,if
<br /> the Information 1 hero provided about this viaale Is mconcet
<br /> D n l have not mixed any of the waste describcd above MOP mry rel::;:i::aaNcu::;.a:.:e,ti:e:,lei ba!Idv Writ,at to GREATER than i,Wo ppm,and thewaelo dovL not contain any POOPP.1
<br /> have provided proper documentation to World Oil Ehvian:ucnmi Sc:v!c.::11,:b.(ntt pre[0.enpllaa Orel tills v:aste was mlxod with other hosardaus acts.I agree to acoupt the aJdilionvl
<br /> .barges forth*Map o..I of this waste 11 the hd.rmmi,n l hn': p:ovi3rt city:n thme:a;tc h:Incu:r.ct
<br /> 00)This wast.IsIron,ettakwhion -O!!.:rswn:x0i!flnfh;v:.:ca'- ,:.:vcm Lo: :n .ca i;Pi; dic• ::S:Gom
<br /> nally..m,tanGm
<br /> quriity g.nm
<br /> erato,(CESGG)eouree..Tetlbu
<br /> ),,I:of..:
<br /> knowledge,tho only waste et!cerdair ed in my Urv/C_!i=,,e,L'a:!:.t::. ::t cr:tj'I:l:i%L'i:';,Nor Cc:'4^_Loure:o.i have net aftsd this waato oil veli;Day other hurn,!ous t^o,tn'._!a ait
<br /> trout other....La.I•.gree to axepl lire:ddiiinna:.bargee In.di::n: I if Phc inform-...:::nose isorIdea ahont thin waste iL In.mroel
<br /> i;;i)S'rrad the-f-Alowing text
<br /> I cerllfy Pant l haven prega+u to places redox,if:,vom:::::r.ae o::.a.:, .._.::.-:.0:e:xl:�.o;4:Ca9=''•::h....0 LeL'rmined le to cconorale.4i patl!.ab!1'",� •..-d
<br /> ... .ti'.a I trvc sal.-!.'fi"r
<br /> pracficaGle meli,aJ ur(reaLmcnl.Y.a:anq,;diz::0cti C:m:ud:•:::-sit.:.,:.::::.,:,: (;:I:stir+:n+'::n,!ne 7rc ':n:::n::Glare liveat m Imm:n:ICs tad tits environn:e._
<br /> e { s plion„ih!L tntlt fill;ilPiGu!P,slnw nd fads.: 0pebt .. -vain;.d s,va.,l villf-r;qn:rq in ins . 7 of n . the ealnoRy to bmdcvatenmr,Out th,Jorgottw-
<br /> eb-da
<br /> adc Cr n «1 <'vc c .t IU,
<br />
|