Laserfiche WebLink
C b O � <br /> :rr.M 0) <br /> Oi0fgg_ v O <br /> =3Memrti O — 00 <br /> G7 N O 2 <br /> M N a <br /> CD - i I1 V I'4 I <br /> rJ L'If tl)fyME-rV TAt_SER - <br /> pit: 'UBA -Ta'.h;tq� O <br /> ' I WORLD 401L <br /> ar <br /> Ira tu;�,ri;••n_i-lir-.l.,rF�Vlc.r•. (D <br /> Vli-1N WAY-r,I".'N.C.1 <br /> www.wDRLD0ILCC)RP.CDea N <br /> rHANSPORTER EPA s CAD428277436 q rf, ?I r.� <br /> 1 �p F� <br /> we now a !Q. <br /> n1 O <br /> paY THr <br /> F <br /> OMER CUSTa�—PURCHASE JRi]ER p RpVTE# TRUCK# <br /> AC <br /> CONTT NA[4tE 4 ~- <br /> ORDER TA1fEii 8V <br /> HgLI0E5 <br /> 'GATE REQUIRED DATE ENTEREG co <br /> _ - NEXT SERVICE DATE CUST0 EpA p U' <br /> mpK. BILL of LADTNGf '� <br /> MANTFEST R (D <br /> PARTa ( i� 1# <br /> QESCtTiPTIQN 7 f 'I <br /> QTY UNIT P ICE QTY Plt•I <br /> T <br /> rn <br /> N <br /> In- <br /> O <br /> CASH RECD: TOTAL n <br /> CHECK# O <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 2,2,1 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_` <br /> OTHER: <br /> DESIGNATED TSDF: rt cat ri:,V lo. , t 4 ' (D <br /> ALTERNATE TSDF: <br /> - _ - - - - ., i.t-t;aa,,. -vet �.Tl } 0• <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC O <br /> (7 <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below It hereby certify first: O <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> �Ri)f have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste does not contain any PCBs,t have <br /> compiled with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the additional charges tar the disposal of this waske if <br /> the information f have provided about this waste Is Incorrect <br /> N <br /> i p2 1 have not mixed any or the waste described above with any other hazardous waste,the III halide content Is GREATER then 1,000 qpm,and the waste does not contain any PCBs I <br /> nave provided proper documentation to World()it Fnvironmenlai Services to rebut the presumption that this waste was mixed wdh other hazardous waste.I agree to accept tho addilionat O <br /> chargee for the dfspasaf of this waste If the information I have provided about this waste Is incorrect <br /> 03)This waste is from a tank which collects waste oil from household"do•it•yourr;6 l"(DIY)and/or conditionally exempt small quantity generator iCESQG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESDG collection tank Is saley from DIY and/or CESOG sources.I have not mixed this waste 61 with any other hazardous waste or waste oil � <br /> rom other sources,I agree to accept the adtlhionef charges for disposal of this waste A the Information I have provided about this waste is Incorrect r <br /> (D <br /> (All generators/customers MUST read the following text <br /> ortrfy that f have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically preclicable and that I have selected the <br /> Icticable method of treatment storage,or disposal currently available to me which minimizes the present and future threat to human life and The environment. <br /> s individual signing in the apace sat forth below on behalf of customer represents and warrants that helstle has the authority to bind cust�oomer,that the forgoing descriptions at waste rOj, (Q � <br /> materials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state an federal regulations,and Wai customer shall abl. .-r - 0 <br /> Se Standard Terms and Conditions on the reverse side of this Service Order. O <br /> Ice Or ,—wllh an assoclafe?Ftezardoub waste manifest(either site specific or consolidated)are subject loan EPA Fee-These f"S ver th EP pass•thr ugh Eee and administratiori - <br /> a¢M ifast program. These fees vary based on Manifest type. Appflcable fees will appear an your billing invoice, <br /> CD <br /> N <br /> (Q er- r n D to Driver Siglbturb f Date 00 <br /> CD 1 rn <br /> 1 Y cn <br /> O 1 1j1 <br /> Print Driver Name <br /> N <br /> N <br />