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<br /> DIXON OFFICE A �.) Y E RONM A 'LIS Vii` ES,, DBS _ �.
<br /> ICF ORDER NO,
<br /> 1-800-727-2879
<br /> FOR ACCOUNTING C;RI_.i..: WORLD OIL
<br /> 562--231-1550
<br /> ENVIRONMENTAL SERVICES
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<br /> S s 7300 CEi 'VRGN WAY, DIXON,CA 05690
<br /> E! �� �(�6 1
<br /> 1-800-727-2870
<br /> 1, WWW. 0RLD0IL.00R .t,GPA
<br /> 1.Di ', r: TRANSPORTER EPA 1!rAI�C3?8277036
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<br /> TOMER# PURCHASE ORDER # ROUTE # TRUCK
<br /> ,.�p _fix. .. .. g.�..pq �.g.'�g��-^:.a..,g.�...:.�-,g—.{.:-r.�.,�:,�..,,.,:,,:,.,..,....�q:««{�.g g''q �p �g ��p{,p HALIDES•- Y&Yf &..r b.f FE8&sx@ F�Y&Bkt F.�Y"B€.b` � ��89 @�i BY WEF----ir-- i3 �.......
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<br /> DATE REQUIRED DAT—ENTERED NEXT SERVICE DATE CUSTOMER EPA BILL of LADING/MANIFEST-#
<br /> — — _, _
<br /> M" '/F..t.f �, s t,_4hl_Z,
<br /> UNIT PRICE QTY P/U TOTAL
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<br /> PART# DESCRIPTION
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<br /> TOTAL
<br /> CASH EC'D: CHECK#�
<br /> WASE DISPOSAL INFOPmATiON
<br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE GOOD 221
<br /> NON-RCCA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> OTHER:
<br /> [DESIGNATED T DF: —
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<br /> A .EPNAT T UF: �
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<br /> DRUM PA : EMPTY }��JIVI -- -- FACILITY: ----—-----
<br /> GENERATOR
<br /> --GENE ATOR WASTE ERTIFI ATION (PLEASE CHECK THE APPROPRIATE BOX)
<br /> By signing below I hereby certify that:
<br /> (Waste oil generator/customer MUST check ONE of the follovvMg three boxes)
<br /> [; tf1)1 have not mixed any of file waste described above witls any other hazardous waste,the lolai habde content Is LESS than 1.000 ppm,and the waste does not contain any PCBs.i have
<br /> complied with the requirements of the applicable Callfornla used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of ibis waste if
<br /> the information I have provided about this waste Is incorrect
<br /> [� #21 have not mixed any of ilia waste described above with any other hazardous waste,the total hailde content is GREATER than 9,000 ppm.and tine waste does not eontai11 any PCBs.I €`s
<br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.i agree to accept the additional i.
<br /> charges for ilia disposal of this waste If the Information I have provided about this waste is incorrect
<br /> D 0),This waste Is from a tank which 006cts waste oil tram household"do-it-yoursell"(DIY)and/or conditionally exempt small quantity geneeator(CESOG)sources.7o the best of my
<br /> knowledge,the only waste all contained In my DIY/CESOG collection tank is sniey€rom DIY and/or OESOG sources,f have not mixed this waste oil with any other haxanfous waste or waste oil
<br /> from other solirces.l agree to accept the additional charges for disposal of this waste if 111e IWO MIafion I[love provided about this waste Is incorrect
<br /> I=
<br /> (All generators/customers BUST 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 ocommillraily practicable and that I have selected the
<br /> practicable method of treatment,storage,or disposal currently available to me which minimizes file present and fulure threat to human his and file environment.
<br /> �g
<br /> This individual signing in€he space set forth below on behalf of customer represents and warrants that he/she has the authority to hind custoiner,that the forgoing descriptions of waste
<br /> and materials are true and accurate as packaged,narked,and labeled,are ready for transportation In accordance with applicable stale and federal regulations.and that customer shall abide
<br /> by the Standard Terms and Conditions on the reverse side of this Service Order.
<br /> -PA Fee. "these fees cover the EPA pass-fhroutih fee anti administration
<br /> Service Orders with r associated hazardous se do manliest typL. pp i specific es consolidated ire r billing
<br /> tir'nn Ce f;
<br /> of ilia of4'Eanifos9 program. These fees vary based on Manifest type. Applicable fees will appear on your billlscl invoic
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<br /> 46 YS_
<br /> Customer Signature Date Driver SIgnature Date E
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<br /> Prlf t e I rlr�f. I
<br /> river Name
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