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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-6(808) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: "'2920277 7 <br /> 562-231-1550 WORLD O i L <br /> ENVIRONIVIEN TAIL SERVICESµ <br /> S <br /> 7300 CHEVRON`,JAY,DIXON,CA 95620 <br /> I TEC OF CALIFORNIA - LOUISE AVE j-say-727 2$79 . <br /> P 2050 E LOUISE AVE WWW.WORLDOILCORRCOM 2050 E LOUISE AVE <br /> E <br /> D TRANSPORTER EPA#CAD028277036 <br /> o LATHROP,CA 95330 LATHROP, CA 95330 <br /> (209)858-4110 (209)858-4110 <br /> CUMMER# PURCHASE ORDER# ROUTE•# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> -TEC605CER-88 f BARRY SCHEDULED-I <br /> . 9nE��� <br /> DATE REQUIRED DATE ENTERE NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 6l24Y118 8/18/2019 CAL000415480 <br /> PARTI. DPESCRIPTION QTY% UNIT PRICE OTY P/U 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 RFWP: CHECK# <br /> - WASTE DISPOSAL INFORMATION <br /> NQN-RCRA HAZARDOUS WASTE,LIQUID-(USED OIUMIXED OILS) STATE CODE 221 <br /> NQNiRGRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> QTHPI: b==RA HAZARD01 IS WASTE S01 In CFILTSRS-C.=-AINING nil I STATE CODE 221 <br /> X 01911 <br /> )I HATED TSDF: YES S i rANAGEMENT.INC:.,Oaa US!ftQl A AZ 85365 92&344-2= <br /> "> A=cunt Manager:Sam Read <br /> . DRUMS P EMPTY DRUMS: FACILITY:___ BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE B.OX) <br /> By signing below I!hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q H)I have not mixed any of tha 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 PCBs.t have <br /> comped w)th the requliements'of 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 <br /> the'lriftirttipitien 1 fire provided about this waste is Incorrect <br /> 0 021 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppin,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 eddttional <br /> charges for the disposal of this waste if the Information 1 have provided about this waste is incorrect <br /> 0 P)'R►is waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CES(IG)sources.To the beet of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank Is soley from DIY and/or CESOG sources.l have not mixed this waste oil with any other hazardous waste or waste off <br /> from other sources,I agree to accept the additional charges for disposal of this waste it the information I have provided about this waste is Incorrect <br /> (Ali generators/customers MUST read the following text <br /> 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 selected the <br /> practicable 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 he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,marked,and labeled.are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions an the reverse side of this Service Order. <br /> Ice Orders with an ass azardous waste mariilost(either site ific or consolidated)ar•e subiect to an E sct2yor the EPA pass-through fee and administration <br /> ass toes vary aced on Manifest type. Applicable teen wM appear on your billing invoic . --- - <br /> Custo r SI re^- Date Signature Date <br /> Print Name Print Driver!Name <br />