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'� r �;. !• �:� - "� S�RUICE ORDER <F®A SIER�iet.'CALL, : : , R ila ASBI�•RY ENVIRONMENTAL SERVICES; DBA . FORM NQ woEsoo4 D (1117) 559=498-Q240;:.: t. O700 f SERVICE ORDER N0. FOR ACCOUNTING BALL. „ '5,02=231 7 550' WODI Y ;:' �.� �;,. � � 253'i RA! xn. AF 166 WORLD OIL ENVIRONMENTAL SERVICES. H 14287 EAST MANNING AVE;'PARLIER CA 93648 QUEST RESOURCE�C rFIRE. l t�1l3E5"f0lVE#(?26746 1-559-498-0240. P ?10. NAMM-R t 4NE Bin MAIN STREET,SUITE'420 e ..W W W:WORLDOILCOIFIR COM 7. ,.�aTC3Crk{Tl l�l,CA '!® TRANSPORTER EPA#CAD 028277036 PRISM,TX 73034 -2403 CUSTOMER# PURCHASE ORDER# ROUTE# TRU,,CC,.yyK# CONTACT NAME ORDER TAKEN BY HALIDES 11T LF�M8B ti SCHEDULE®-! DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# . BILL of LADING/MANIFEST# i . PART* DESCRIPTION QTY UNITPRICE CITYP/U TOTAL OIrR)CNONPOf�IFqRMIN, OIL FILTER: , 04040 ,' TOTAL CASH.RECD.'. CHECK:# e 4300y . A WASTE DISPOSALINFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE-CODE 221. NON-RCRA HAZARDOUS WASTE,LIQUID.(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER:. 4AZARR�PJS,W=1�8;4.10(FILTERS wpli.= ESIGNATED TSDF: ALTERNATETSDF: 'w. DRUMS EMPTY DRUMS: FACILITY. BSC EEE J GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) t . RY signing below I hereby certify that (Waste oil generator/customer MUST check ONE of the following three boxes) Mill)1 have not mixed any of the viaste.described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any P.M.I halve complied with the requirements of the applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is Incorrect #21 have not mixed arty of the waste described above with arty other hazardous waste;the total halide content is GREATER than 1,000 ppm,and the waste does not contain.any PCBs.I have provided proper documentation to ftdd OR Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.)agree to accept the additionalcharges for the disposal of this. waste If the information I have provided about this waste is Incorrect - ;i" 60)This waste isfrom a tank which.collects waste oil from household"daft-yourself"(DIV)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knoWl dge,the onlyi caste oil contained .In my DIY/CESQG collection tank is coley from DIY and/or CESQG sources.I have not•mixed this.waste oil with arty other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this wastedf the information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text and check the associated box.) A, 4)If I am a large quantity generator,I certify that I have aprogram In place to reduce the volume and toxicity of waste generated tothe degree I have determined to be economically practicable and that I have ted the practicable metFpd of.tfeatment,storage,or disposal currently available to me which mhtlml*the present and future threat to human fife and the environment,Or,IfI am a srnall quandty generator,I have made a good faith effort to mktimize'my waste generation and select the best waste management method that is available tome that I can afford.. ' This Individual signing in the space Sit forth below on behalf of Customer represents and warrants that he/she has the authority to blnd Customer,that the,f ng descriptions of waste and materials are true and accurate as packageQ marked and labeled,are ready for transportation In accordance with applicable state and"federal regulations;and that Customer shaltabide an bound by the.Standard Terms and Conditions on the reverse side of this Service Order. Omer Signature Date Driver Si to �,,� V71 Print Name I Print Drivers Names ::