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SERVICE ORDER <br /> FOR SERVICE CALL: <br /> DIXON OFFICE ASRURY ENVIRONMENTAL SERVICES, OSA FORM NO.WOES004-B (4/17) <br /> 1-800-727-2879 SERVICE ORDER N0. <br /> WO 3 <br /> FOR ACCOUNTING CALL: ' <br /> 562-231-1550 tAfODIY <br /> AF <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> s 7300 CHEVRON WAY,DIXON CA 95520 <br /> " PHILLIPS AUTO CARE 1-800-727-2879 <br /> P 1003 MOFFAT BLVD WWKWORLDOILCORP.COM 10113 MOI=FAT BLVD <br /> E <br /> T MANTECATRANSPORTER EPA CAD028277036 <br /> , CA 95336 MANTECA, CA 95336 <br /> 0 (209) 239-1551 Mai k (209) 239-1551 <br /> CUSTOMER# PURCHASE ORD R# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> PHIQ20 ER-88 MARIA squirltana <br /> 'DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 218/2018 CAD982026429 <br /> PART'#• DESCRIPTION QTY UNITPRICE QTYP/U TOTAL <br /> .OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 1 $Q00 I $0.00 <br /> OF USED METAL OIL AND GASOLINE FILTERS 155•04 $55.00 <br /> i' <br /> t OF 1 ME AL BATCHO <br /> i; <br /> 1' <br /> Crc ss Streets: TOTAL ' <br /> CASH REC'D: CHECK# Accaunt Manager. Steve Gately <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUM(XED OILS) STAT~CODE 221 �[ <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODS <br /> OTHER: —NeN 4I-fA�RSeU&WASTE,SOLtDiF L-TERS C-OW-tINNG-O <br /> DESIGNATED TSDE: <br /> ALTERNATETSDF: MA YES LLC,2734 E 13TH 5T, 85 ,S 8 42 <br /> LIDRUMSU: EMPTY DRUMS: FACILITY: BSC <br /> rti ll "} 417 t <br /> i 1 ti R-11I 1 L <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) f <br /> By signing below I hereby certify that: L --'--j <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> =w)I 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 PCHs.I have compiled with the requirements of <br /> 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 <br /> =J#2€have not mitred any ofthe waste described above with any other hazardous waste,the total halide content is GREATER than 1,o00 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this <br /> waste lithe information 1 have provided about this waste is incorrect <br /> =1.3)This waste Is from a tank which collects waste oil from household'do-It-yourself'{IDN)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil Contained <br /> in my QIYICESQG collection tank is Weir from 01Y and/or CESQG sources.t have not mixed this waste oft with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal <br /> of this waste if the Information I have provided about this waste h incorrect € <br /> i <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> )if I am a large quantitygenermo,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have <br /> selected the practicable method of treatment storage,ordlsposal currently available tome which minimizes the present and future threat tb human life and the environment;Or,if I am a small quantity generator,I <br /> have made agood faith effort tnminimize mywaste generation and select the best waste manage enc method that lsav ifable tome a that 1 can afford <br /> , <br /> ua si nim in the space set forth below an behalf of Customer represents and warrants that he/she has the authority to bind Customer,that the forgoing descriptions of waste and materials are true and accurate <br /> isIi 9 g P <br /> d be the StandardTetmsand andillonsartthereverse <br /> re u at ons and ilial Customer shat(abI a and b y <br /> O s o atlonina[cordancewitha Ilrattlestatoandfederal g l I <br /> ked andla6eled,areread fartr n rt pp • <br /> mar P <br /> aspackaged, Y <br /> Yr <br /> Order. - <br /> 21i3r�:IS <br /> nature Date Driver Si tune Date <br /> 9 <br /> Print Name Prin v ' Nam <br /> I <br />