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• SERVICE ORDER ' `!
<br /> FOR SER\IQC 2 CAt_L: }{ :
<br /> -04-JB tg17l
<br /> ASBPRY EV..IRONIMENTAL SERV)CES, DB.A FORMNOVOESn
<br /> DIXON OFFICE SERVICE ORDER NO..
<br /> 800-727-2879 ..
<br /> FOR ACCOUNTINGCALL: �., f •.,s
<br /> 5G2-2$7'-�-500, .. �t:" - .. •r::,::;.. ,. � . . 7 .: •
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<br /> WORLD OIL
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<br /> ENV-IRONMENTAL SERVICES.r.,
<br /> s ti 7300 CHEURflN WAY;DIXON CA-95620 � 1.� T I' +�7 IC t�lw.mama• =lrtc
<br /> ��- :P1REW'ONE:,"#3566.1.4 1•son-72?-�$7s' I
<br /> P, J4l:t�rE,'ru;N-l�lTF fhL l r �", r3'i 75 k1AW 5'TRE 'T.",'J4T A
<br /> p WWW.WORLDOILCORRCOfvT
<br /> T 1"rffid, ,CPit g 70 . TRANSPORTER EPA.#CAD028277036
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<br /> CUSTOMER# PURCHASE ORDER-# . 'ROUTE# TRUCK# CONTACT NAME URDER"fAKENBY HALIDES ¢
<br /> 0I-1c.,DULI-E,,D-I I
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILLof LADINGIMANIFEST
<br /> yrf'ART# DESCRIPTION QTY UNIT PRICE QTY.P/U TOTAL =..
<br /> - �.e1,.M-10 PAW$lit AS 1ER cu!l -r oIItfIVE"c)N1Ar"d!fyE'f0 G'AI f
<br /> C71'f�N AiY_F r••"rPl1A.11T 7•�]t"1+�slag-rwNI, BATCH 4
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<br /> iE st ire 7J J {)t ':at3tVics?•a.ris�r��•u�it17 a�aaol tctl:P3=t '.iaS* M0n1ie(,.t5('ltb P�c'rlivins�zlrywllci 'aC J qr�t sok j l.kcr:zli fn?I�F'ma..FAM
<br /> Ver -VA 1� s
<br /> CA$H[gC'D:.! CHECK 11
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<br /> WA5i'E D,ISP.OSAL INFORMATION
<br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 -
<br /> NON=RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> }
<br /> OTHER:
<br /> DESIGNATEDTSDF:
<br /> ALTERNATE TSDF: i
<br /> • I
<br /> DRUMS P/U: EMPTY DRUMS: FACILITY' BSC
<br /> . i
<br /> GENERATOR WASTE CERTIFIC (PLEASE CHECKTHE APPROPRIATE BOX)
<br /> 'By 4�r?frhelaw.l hereby certVfy that:.
<br /> (Waste ofl.generator/custo.rnpr MUST check ONE a .tF�e following three boxes)
<br /> po11 l h¢vc not n5lxed'any of the vas;c desrn�ed ahoveQth any'oih&hazardous Waste,the t¢ta1 halide contends LESS than 1p00 ppm,and rhe wasc4'doas notsonrain any Kits,I have'Compit d tivkh the s lncorrvc rrts hf
<br /> t}iu apphcaWe Callfarrila used oil manage rMnt icguladvns ro determine this!s true-I agree to accept the addddanod charges'lorthe dhp ssal of this waste If she informadan I have provided abtlul dd5 waste Is 1nCnrm¢Y I
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<br /> pfl21 iavinaetrrtxed any'6(the waste described;above whh any other hazardous waste,the total haiide content Is 0WEII than 1,000 ppm,end the waste does nut containAny PCBs.I
<br /> haV¢pfdEhded proper doaimentatio'ri taVJaFid.MEnv[ronmentat 5ecvices to rehur she presumption that this*asre was mixed with other haradouswaste.I agree to accept theadditfnn¢I,chargesfoe the ildsposal ofthis.
<br /> . waste ir`the Ydvrmation 1 have provided ahoutthls wasters Incerract. - - •• - -
<br /> ; iS,
<br /> '=343lTktkiyaste h from stank which callacis waste oil fram•household do-Ft-yeIurs r'(Diy1 ondlar•tondhi0rauy eKel»prsmailquantity generator ICESgG}'saurces.•7o the 6dst'af my knnwietige.lheanlyY+aswnil contained
<br /> 1n my 01Y1 CL•sC1G cvllecnor5 tank is coley from DIY androrCESgG sources.I havo�ngt mixed t_hls waste oil wdth'any other hazardous waste or Was tendi from nt}acrsaurcrs.I agree to Accept the addhional charges fordisposal-
<br /> of this wa%o It thednfonnatJa,l l have PFGvldad;&.ut thlswasta Is Incorrect -
<br /> v
<br /> (All generators/custorrlers MUST read the fallowing text and chi=ck th'e associated•box.),
<br /> illi41 If I am a large quantltyr gerK-rata4l Certify Uhat I have a program In place to rgduce the veiurmand wxicky uFwaste generated to the di I determined.to be ecwmmdcally practicable and that I have.
<br /> ti ted the prac'ticdbla method,of treatment,storage.atdlsposal cunendy avaidabld to mo which mir kilxes the present and future threat rohurpk_ Ilfe aril the environment;Oro if am a anal!quandtyganeratar,I
<br /> ./I• -
<br /> hate made a geld faith effort to minlnllze mywa;te genemtlon and select the-best wave management rrlethod that is oyailable to m¢that I�r�rS'affcrd,
<br /> This Indivtds,af signing ks 11r@space sat forth below wt 4ehalloFCustomer refxesen"nd warrants drat helshe Jias the authorltyto bled C ctamer,that the tgrgvlrxa rlesctiptiens ofwastgand nhalerlsisase trtreand accurate
<br /> as packag¢d,marked and labeled,Are ready for transparwrlDn In accordance tMth appticable state anti federal regulations,and 1}at. iislamer shall abddfi ype p'e baund by the standa[d7arms and Condluvns an the ea¢se
<br /> side ofthls Servicegriler. - 1 j '
<br /> •'C ❑merr•'yriatt�re ; Date fit:, _ sist a Driver S: I at ,e D eA
<br /> Prior Nettie • . Print Drivers Name
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