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FOR SERVICE CALL: SLE,[1VIGE 0 R D'EHR rORI1'I NG.t,�4rOCS0iJ�-B(8118}. <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA - <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: 142881999 <br /> e' LD 01 L <br /> 552-231-1550 ` �`� <br /> ENVIRONMENTAL SERVICESTM <br /> H 7300 CHEVRON WAY,DIXON,CA 95620 <br /> 1-800-727-2879 <br /> P TEC OF CALIFORNIA -LOUISE AVE <br /> E 2050 E LOUISE AVE 1�VWW.WORLDo1LCpRP.GOM 2050 E LOUISE AVE <br /> D TRANSPORTER EPA#CAD028277036 <br /> o LATHROP,CA 95330 LATHROP, CA 95330 <br /> (209)$58-4110 (209) 85$-4110 <br /> CUSTOMER# PURCHASE ORDER# 'ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> TEC605 -1 q l CER-86 BARRY SCHEDULED-1 <br /> DATE REQUIRED •DATE ENTERED NEXT SERVICE DATk CUSTOMER EPA# - BILL of LADING/MANIFEST# <br /> 3113/2019 3/512019 CAL000415460 <br /> PART# - DESCRIPTION QTY UNIT PRICE QTY PN TOTAL <br /> OF USED METAL OIL AND GASOLINE FILTERS 2 $55.00 $110,00 <br /> OFDR OIL FILTER DRUM[REPLACEMENT- NO CHARGE 2- $0.00. $0.00 <br /> 'BATCH .- <br /> TOTAL <br /> CASH RECD: CHECK# <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 /> OTHER: <br /> DESIGNAT E HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 <br /> ALTERNATE TSDF: 1�S�{1ANA�11�1��C:;'�5U1}C75}�I�I�ITAY"�5;4 $�g�•�--$g�j--.__.___..._.__�___�...� <br /> R <br /> rosy Accou IVfana`�e :-dam IZ'sa __. <br /> DRUMS PIU- EMPTY DRUMS: . FACILITY:_-�_ BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/Customer MUST check ONE of the following three boxes) <br /> 0 01)1 have not mixed any of the waste described above with any other hazardous waste,tho total hallde content is LESS than 1,000 ppm,and the wasto does not contain any PCBs.[have <br /> compiled with the requirements of the applicable California used oil managemont rogulations to determine this is true,I agree to accept the additional charges for the disposal of this waste It <br /> the Information I have provided about this waste is incorrect <br /> 021 have not mixed any of the wasto described above with any other hazardous waste,the total halide content is GREATER than 1,400 ppm,and the waste does not contain any PCBs.t <br /> have provided proper documentation to World Oil Envirorraw ental Sofv%;er,to rebut the presumption that ti:is wasio wut;nixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste It the lnformation i have provided about this wasto is Incorrect <br /> [] 03)This waste Ic from a tank which ccitectc wista oii fr::!i hn'...ehold"do-H-yourself"(01Y)rind/or e,orid:ticna:ly axempt small aunntity gonerator(CESOG)sources.To the bast of my <br /> knowledge,the only waste cli cortained In nay DIY!CESQG colmr•Ilon°a!:k is sofey frrar.MY anedor CESOG:rets.cos.€hove not mixed this tvetste oil t:ith any other hazardous tvoste or waste oil <br /> from other sources.I agree to accept tl.c additloral ci:a,eS to( of this waste if the inflot-?;Ittion llh.pvc r r.—Y-Adad about this waste Is incorrect <br /> Gill atemerators/customers, MUST read the following text <br /> i certify that I have a progriann in pitace to reduce lite:'cl'.!rli:)intd it"xicity f,t t:'::.`.V f!.uncr >-Cd ti:thvC•degrc--):`-t%;tir-te,(nircd lo I;o cconamict:ily i3motical3ic and that I have s0c.c1lej the <br /> Fru(ticsahte meti?oci of toe:;::rent,)tvr:+:je,pr Cil i:U:i i l iit'i !iii:e t'.V:?iizlJi_` firs t'!}ei•::[T:ii?{;IIiZi: t:!'C it:if i•tY i 7:JlCtYp ilio S t to hur ivi?We end the environment. <br /> This individual signing in$ho arccc riot iii;ti?::FIG:i cit:..:Il ''Ui Gil tO:e:•if::-n:e= :e:i:.;i:!•.JT.t:'i.:ii_t:; iii.".!cities::;:r the aumodiv to:?:!ir:cu:to ler,titan the fornoing descriptions of vi. <br /> .r !•• ' 'C r + i'�•^ t re ulrtlons,and that ct)ritomer;hall ablde <br /> and lttaiCrlt?iSiil•A.UL•a:tC-:tCCUr{:t()a:i-paa:i:iljfra�;;..,at;t:.ia.:.i tai L"'iG•,:•,i:!'J f.•.:ii ..:.:i.^+;..i::.:t:J..::?�.:i:i:C!'(:::7:::_v:ittl i:.^.:2:i..:SC..::[Jti I:iii1 iG��t'.^.l y <br /> by the-+Standard Tera.arae Condstions c•:.,:i'+ru: ..i.::r_....of <br /> a r ;a •.,., +•.., .an ',: -;.1-. ...• ::{:•.eo._t•f'•: - :� iriiiiif5riitie: <br /> $Cn',C_ i?:. ^CI:itCL,he.....f:if:t:t ., r::c'!:il t tt C e T. .. co <br /> tilt :i. <br /> Of tiro di:{7n �8t i7f�cwiiI(n`'•r:a`r•.::�.'ieos V.lt t::'•*:.; ..... •" .. <br /> „"^�•��._ - � _�...-�-.7..—.fir ~- <br /> r <br /> /L.•t.i:it�Ii�1r?I••';y�•�..r�'t:ir't=: __.�.._. -f. - ------ <br /> 0_3- ..- '3 .. .._..'•L :.�i_:. <br />