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FORSERVICECALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-$00-727-2879, SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: N2889154 <br /> 562-231-1550 ()WORLD O 1 L <br /> ENVIRONMENTAL SERVICES <br /> H 7300 CHEVRON WAY,DIXON,CA 95620 <br /> I TEC OF CALIFORNIA.-LOUISE AVE 1-800-727-2879 <br /> E 2050 E LOUISE AVE vuyvw.WORLDoiLcoRPCOM 2050 E LOUISE AVE <br /> Q TRANSPORTER EPA#CAD028277036 <br /> ..T. LATHROP,CA 95330 LATHROP, CA 95330 <br /> •0 (208)858-4110 (209) 858-4110 <br /> CU$TQMER# PURCHASE ORDER# ROUTE# TR,UCK# CONTACT NAIIIfE ORDER TAKEN BY HALIDES <br /> TEC805 CER-86 � BARRY SCHEDULED-1 <br /> DATE REQUIRED DAT MEN <br /> TERED NEXT SERVICE.DATE CUSTOMER•EPA# BILL of LADING/MANIFEST# <br /> 5/13J2019 5/7/2019' CAL000415460 <br /> PAR •'''•'r "WSCRIPTION •`' OTY UNiT PRICE:OTY P/U TOTAL <br /> OF . ~: 'AL OIL AND GASOLINE FILTERS' '! $55.00 -' <br /> :r DRUM REPLACEMENT-NOCHARGE 1 ir,'r -1'.. $0.00 <br /> 7 • + <br /> TOTALt to <br /> IkCK <br /> WASTE DISPOSAL INFORMATION <br /> :NQj :HA,, R1S WASTE,LIQUID(USED OIL/MIXED OILS) STATE.CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL-SOLUT'ION$) STATE CODE <br /> OTHERpTHER: NON•RCRA HAZARDOUS WASTE,SCUD(FILTERS C6NTAINiNG OIL)STATE CODE 223 <br /> VATED TSDF: YES MANAGEMENT,INC.,6500 US HIGHWAY 95,YUMA,AZ 85365,928-344-9828 <br /> AL^TEJ <br /> .. .:( _ • ' aeount Wanager Sam Read <br /> .. . i. <br /> PAR Iyi •P EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> Bp•fatonl-Og below 1 hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> a1)tlhaygpot ml>fed arty,of the waste described above v.dth any other hazardous waste,the.totsl hailde content Is LESS than 1,000ppm,and the waste does not contain any PCBs.I have <br /> torsi with�tiegiilrpoletnts of the applicable Cailfor used oEl management regulattona to determine this Is true.l agree to accept the additional charges for the disposal of this waste if <br /> 1'� <br /> the informatlgn l fsave provided about thla waste Is Incorrect.'.. , <br /> -0 02 t have not mixed any of the waste described above with any other hazardous waste,the total halide contept is GREATER than 1,001)ppm,and the waste does not contain any PCBs.l <br /> have provided proper 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 for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> Q #3)This waste Is from a tank which collects waste oil from household"do-It-yourself"(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,theonly waste o)l contained In my DIW CESQG collection tank ts•aolay from MY and/or CESQG sources:I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.I agree to accept the additional charges for disposal of this waste If the Information I have provided about this waste is Incorrect <br /> (All generators/customers MUST readsthb following text <br /> I certify that t 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 selected the <br /> piOoablo method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This Individual signing In the space set forth below on behalf of customer represents and warrants that hdshe has the authority to bind customer,that the forgoln(I descriptions of wasta <br /> and materiots-ara true and accurate as packaged,marked,and labeled,are ready for transportation In-accordance with applicable state and federal regulations,and that customer shell abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee.These fees cover the EPA pnss-through fee and administration <br /> the eManitest program. These fees vary based on Manifest type.Applicable fees will appear on your billing Invoice. <br /> r Date Driver Signature Date <br /> � ► r ( ��1 <br /> Prins Name rint Driver Name <br />