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FOR SERVICE CALL: SERVICE ORDER FORM N0 WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES. DBA <br /> 1-800-727-2879 SERVICE ORDER N0. <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> Si 7300 CHEVRON WAY. DIXON, CA 95620 <br /> a 1-800.727-2879 <br /> r WWW.WORLDOILCORP.COM <br /> TRANSPORTER EPA#CAD028277036 <br /> r <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING!MANIFEST a <br /> 7HAZARDOUS <br /> DESCRIPTION OTY UNIT PRICE CITY P/U TOTAL <br /> TOTAL <br /> CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> RDOUS WASTE, LIQUID(USED OIVMIXED OILS) STATE CODE 221 <br /> ARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> DF: --_— _ _ - -- - - -- - - -- —- — — --- -- - <br /> -- <br /> ALTERNATETSDF: - -- - — -- — -- <br /> DRUMS P/U: EMPTY DRUMS: FACILITY:— BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below 1 hereby certlty Thal: <br /> rnl (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> L� x1)1 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.I have <br /> compiled with the requirements of the applicable California used oil management regulation.to determine this is true.I agree to accept the additional charge.for the ol.posel of this waste It <br /> the Information I have provided about this waste Is Incorrect <br /> D aQ 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER then 1.000 ppm,and the waste does not contain any PCBs.I <br /> have provided peeper documentation to world 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges forme disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> D 13)This wsafe is from a tank which collects waste oil from household-daibyourseff (DIY)and,oe conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge.the only wasto oil contained In my OIY/CESOG collection tank Is Soley from DIY and/or CESOG sources.I have nal mixed this waste oil with any other hazardous waste or waste oll <br /> from other sources,I agree to accept the additional charges for disposal of this waste Il the Information I have Provided about this waste is Incorrect <br /> (All generators/customers MUST read the following text <br /> I certify that I have a program in place to reduce the volume end Iezlclty of waste generated tome degree I have detemone r to be economically pmcllcable end that I have selected the <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future throat to human life and the environment. <br /> This Individual signing in the apace set forth below on behalf of cu Stouter represents and warrant.that rented hes the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate e.packaged,marked,and IabekW.are toady for transportation in accordance with applicable state and federal regulation.,and that customer shell abide <br /> by the standard Terms evil Conditions on the reverse side of this Service Order. <br /> Service Order;with an associated hazardous waste manifest either elle epecllic or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration <br /> ( <br /> of the steamiest program. These lees vary based on Manifest type. Applicable fears will appear on your billing Invoice <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Driver Name _ <br />