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FOR SERi/10E CALL: <br />DIXON OFFICE <br />7-800-7-ASBURY WO <br />FOR ACCOUNTING, CRLL: V�fODIY <br />562-231-1550 <br />r ��� <br />PEP BOYS #0711 <br />4987 WE51" LANE <br />STOCKTON,CA 95210 <br />(209) 952-1222 <br />k �• !:. �• • � �� <br />• � • <br />L7I j� °j� ;� ; € <br />•��� <br />7300 CHEVRON WAY, DIXON CA 95620 <br />i-800-7-ASBURY <br />W W W. WORLbOILCORP.COM <br />TRANSPORTER EPA # CAD028277036 <br />THE EC GROUP <br />201 E. ORCHARD ST. <br />HAMMON70N, NJ 08037 <br />(800) 334-3794 <br />CUSTOMER# <br />PURCHASE ORDER# <br />ROUTE# <br />TRUCK# <br />CONTACTNAME <br />ORDERTAKENBY <br />HALIDES <br />pEp359 <br />124 <br />SCHEDULED -i <br />DATE REQUIRED <br />DATE ENTERED <br />XTSERVICE DATE <br />STOMER EPA# <br />BILL of LADINGlMANIFEST# <br />6/27/2017 <br />6/27/2017 <br />81682844 <br />�`� ���2"� <br />PARTlt <br />DESCRIPTION <br />QTY <br />UNIT PRICE <br />QTYP/U <br />TOTAL <br />Vd0 <br />USED OIL i MIXED OILS <br />WOSC <br />USED OIL, SERVICE CHAR <br />1 <br />.'' - <br />,� <br />BATCH # <br />Cr <br />S <br />Streets; <br />TOTAL <br />/ /' <br />!� �v"I <br />CASH RECD: <br />CHECK # <br />WASTE DISPOSAL <br />INFORMATION <br />NON-ftCRA <br />HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) <br />STATE CODE 221 <br />NON-RCRA <br />HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />STATE CODE <br />OTHER: <br />_ <br />DESIGNATEDT5DF:RSBtlFZY-ENVIRONMENTAL SERGICES�GERES;182p7JIOftC�1i4N Rp:TCERES;"IIA;"95356(2p8)54tYB25� CRL4p0a9388U <br />ALTERNATE <br />TSDF: <br />DRUMS P/U:_ <br />EMPTY DRUMS: FACILITY;_ <br />BSC <br />GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br />Bysigning below I herebycerdfy that <br />(Waste oiIgenerator/customer MUST check ONE of the following three boxes) <br />tlt) f havenotmlxed any o/the waste described above with anyather hazartlouswasfe, the total halide content is LESSthan 1,000 ppm, and the waste doez not confaln any PCBs, l have complied with the requirements o/ <br />heapplicable Callfwnla medoll managementregulatmns to determine this Is Uue.l agree [o attept lheaddhlonal charges forthedlsposal of Ihls waste if lhe(nformation I hove provided aboutthlswasle is Incorrect <br />r�q2 i have not mlXed any of [he wazre tlesrdbed above with any other hazatdouzwaste, the brat halide content is GflEATEfl than t,000ppm, and thewaste does notcontaln any PCgs l <br />have provided properdocumentaiion to world OiI EnvironmenRl Services turebut the presumption that this was[ewas mlXedwlthofher havrdoes waste, I agree to accept the additional charges fmthe disposal of this <br />waste If the Infolmaliod I have provided abou[[hiswaste is incorrect <br />C1a3)Thts waste is from stank whlchcallects wasteollham household•dait-yourzelf"(DIY) and/arconditlonallyexempr small quantity generatorfCESQG) sources. To the best ofmy knavledge, [he onlywaste oil <onlalned <br />In my olY/CESQG colle<tlon ta�issaley fmm DlY and/w CFSQGsovr¢es.I have not mixed thk waste oil with any otherhaurdous waste anvasteallfrom othersources.l agreetoaccepl the additional charges /ordtspoml <br />of thiswaste If the information I have provided about Nis waste Is incorrect <br />(All generators/ customers MUST read the following text and check the associated box,) <br />%4S if i am a large quantitygenerator, l cezti(ythat i have a program In phce to reduce she volumesnd toxicity ofwastegenerated [o [he degree I have determined to he economically prartiable and than have <br />ected the practicable method o(treatmene,storage, or disposal currentlyavallable ro mewhich minimizes the present and future threat to human II(e and the environment:Or,3i am a small quantity generator, I <br />Ira adeagood(ailheffortto minimize mywa to generationand seler[thebest waste managementmelhod that is available to melhatican afford. <br />Thtsindivldual signing In the spaceset forth below on behal/of Customer represents and warrants that he/shehas the au[horiryto bind Customer, that the forgoing descrip[Ions ofwazte antl materialsaretrue andaccumre <br />as packaged, marked and labeled are readyfortramportation in accordancewilh appllcahleslate and federal regulatiom, and That Customer shall abide and be bound by the Sdndardietmsand Condl[ions on the reverse <br />sideotthis Service Order. / <br />/ �({/� <br />t % %1jf� <br />C/�}t�j mer Signature Date {Y' <br />/ .Q. ��f'n.07 <br />Print Name Print Drivers Name <br />