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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> N2957976 <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> 7300 CHEVRON WAY,DIXON,CA 95620 <br /> TEC OF CALIFORNIA- LOUISE AVE 1-800-727-2879 <br /> P 2050 E LOUISE AVE WWW.WORLDOILCORP.COM 2050 E LOUISE AVE <br /> E TRANSPORTER EPA#CAD028277036 <br /> D LATHROP,CA 95330 LATHROP,'CA 95330 <br /> 0 (209) 858-4110 (209) 858-4110 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> TEC805 CER-86 BARRY SCHEDULED-I <br /> e70//-/ i <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 7125/2019 7/17/2019 CAL000415460 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU 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*REC'D: CHECK <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS). STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAININO OIL)STATE CODE 223 <br /> DESIGNATED TSDF: 05W5' <br /> 0500 US HIGHWAY TUfWA,A7- <br /> AIJERN E TSDF: } . <br /> ross <br /> DRUMS P/U: �z 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 /> #1)l have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,Oo0 ppm,and the waste does not contain any PCBs.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true.1,agree to accept the additional charges for the disposal of this waste if <br /> the Information I have provided about this waste is incorrect <br /> 0 #21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs. <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.1 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 /> 0 #3)This waste is from a tank which collects waste oil from household"do-It-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is soley from DIY and/or CESOG sources.l have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.l agree to accept the additional charges for disposal of this waste if the lhformation I have provided about this waste is incorrect <br /> (All 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 1 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 on the reverse side of this Service Order. <br /> Service <br /> the Orders with an <br /> program.These fhazardous ees vary based to Manifestt(either site specific <br /> able or consolidated) <br /> n olida appear on your biare lling ect an EPA Fee.T s cover the EPA pass-through fee and administration <br /> -7 �e. <br /> �I <br /> fcuDate river Signature Date <br /> d� Z <br /> - / <br /> Print Driver Name <br />