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ASBURY ENVIRONMENTAL. SERVICES, DBA FORM NO.WOES002-B (5/18) <br /> FOR SERVICE CALL: <br /> DIXON SERVICE ORDER <br /> 1-800-727-2879WAR <br /> FOR ACCOUNTING CALL: NO. N <br /> 562-231-1550 WORLD OIL , <br /> `WA 7300 CHEVHON WAY DIXON,CALIFORNIA 95620 (800)727-2879 <br /> EPA#CAD028277036 <br /> Date Customer# <br /> Customer EPA# <br /> Address Commodity <br /> City State Zip Halides PPM <br /> Phone Contact Amount <br /> Cash ❑ Check# <br /> Notes: <br /> Waste Disposal Information <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(OILY WATER)STATE CODE 135 <br /> ❑ OTHER <br /> MANIFEST# <br /> NEXT SVC DATE DRUM SIZE QUANTITY TRUCK NUMBER_ <br /> DESIGNATED TSDF: <br /> ❑ WORLD OIL RECYCLING*2000 N.ALAMEDA STREET*COMPTON,CA 90222*CAT080013352*(310)537-7100 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES*2549 SCOTT AVENUE'CHICO,CA 95928 CAL000827844*(800)733--9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO Il,LLC*1618 W.5TH STREET'CHICO,CA 95928*CAD980694103-(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA*200 DINSMORE DRIVE'FORTUNA,CA 95540"CAL930256136-(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES*7300 CHEVRON WAY*DIXON,CA 95620'CAT080012602*(707)693-6008 <br /> ❑ YUMA YES LLC*2730 E. 13TH STREET,YUMA,AZ 85365-AZR000515924'(928)643-8938 <br /> ❑ RAMOS ENVIROMENTAL' 1515 S. RIVER ROAD'W.SACRAMENTO,CA 95691 'CAD044003556*(916)371-5747 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES'1920 MORGAN RD,STE AES`CERES,CA 95358"CAL000393680*(209)541-1825 <br /> ❑ BAKERSFIELD TRANSFER NC.* 1620 BRUNDAGE LANE' BAKERSFIELD, CA 93307.CAL000282598*(661)377-0308 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC. 14287 F.MANNING AVE' PARLIER,CA 93648' CAL000102751 *(559)498-0240 <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby cei that, <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> (❑Nip 1 have not mixed any of the waste described on the service order noted above.with any other hazardous waste.the total halide content is LESS than 1,000 ppm,and the waste does not cc main any PCBs.I have complied with the requirements <br /> of the applicable California used oil management regulations to determine this,s 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. <br /> (F7#2)I have not mixed any of the waste described on the service order noted above with any other hazardous waste,the total halide content Is GREATER than 1 AOg ppm,and the waste does not contain any PCBs.I have provided proper documentation <br /> to World Oil Environmental Services to rebut the presumption that this waste was mixed with other haaaaieus waste.I agree to accept the additional charges for the disposal of this waste if the information I have prevlded-about this waste is incorrect, <br /> (❑tQ This waste is from a tank which collects waste ail from household"od-t-yourself(DIY)andlnr conditionally exempt small quantay generator(CESOG)sources.To the best of my knoMedge,the orly waste oil contained in my DIY/CESOG <br /> call-l—tank is solely from DIY/CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the information I have provided about <br /> this waste Is Inconect. <br /> (All generators/customers MUST read the following text) <br /> I certify that I have a program in place to raduca the volume and toxicity of waste generated to the degree I have determined to bo economically practicable and that i have selected the practicable method of <br /> treatment,storage.or disposal currently,available to me which minimizes the presont and future threat to human Iiia and the environment. <br /> Thislndividual signing in the space set forth betow on behalf of Custemer represents and warrants that helshe has the authority to bind Customer,that the forgoing description of waste and materials are true and accurateaspackaged,marked and <br /> �Iad,are ready for transportation in accordance with applicable state and federal regulations and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />