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-.• - i rr. <br /> 171 <br /> FOR SERVICE CALL: SERVICE ORDER 'FORM NO.WOES004-8(0/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERV(CE ORDER-NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: <br /> 562-231-1.550WO , �O I L <br /> ENVIRONMENTAL SERVICESTM <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> P TEC OF CALIFORNIA-LOUISE AVE 1-800-727-2879 <br /> P 2050�E LOUISE AVE WWW.WORLDOILCORRCOM 2450 E LOUISE AVE <br /> � TRANSPORTER EPA#CAD028277036' <br /> T LATHROP,CA 95330 LATHROP, CA 95330 <br /> (209) 858-4110 ; (209)858-4110 <br /> CUSTOMER PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALID.M. <br /> TEC605 . CER-86 BARRY SCHEDULED-1 <br /> DATE REQUIRED. DATE ENTERED NEXT S VICE DATE CUSTOMER EPA# BILL of LADING/IVIAIVIFEST.# <br /> 8/2342019 9/1.7/2019 CAL000415460 ' <br /> PART`;it DESCRIPTION QTY UNIT,PRICE QTY PIU... :• TOTAL <br /> OF. - USED METAL OIL AND GASOLINE FILTERS 2' -155.00 a $110.00. <br /> OFDR OIL-FILTER DRUM REPLACEMENT-NO CHARGE 2 1600 $0.00 <br /> BATCH <br /> TOTAL <br /> CASH-RE'C'D: CHECK# <br /> WASTE DISPOSAL INFORMATION ' <br /> NON-RERA HAZARDOUS WASTE,LIQUID(USED-OftJMIXED OILS) STATE CODE 221 ` <br /> NON=RCRA HAZARDOUS WASTE,-LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE "'•"�' <br /> 'OTHER.: ftapkl I Deg • <br /> DESIGNA <br /> ALTERNATE•TSDF: <br /> _C.r9 r. ��: A=unt Managehr Sam Read <br /> 7. <br /> DRUMS P/U. 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)[have not mixed any of the waste described above with any other hazardous waste,the total halldecontent is LESS than 1,000 ppm,arld the wasteY'ges nQt co¢td any .htVs. . <br /> complied,with the requlremertta'of the applicable Caltfarnia.used ell management to determine this is true.i agiee to accept the additlorta!ctearges.itir ttie di� osal bt th(s Wdwlf.• <br /> the Informstlon-1 have provided'about this waste Is Incorrect :,.�.•,:; <br /> #21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER-than 1,000 p0m-egnd tlie:wpsle,doosr dicontain 86Y PCBs..) <br /> have provided proper documontatiorr to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazdfd66s`WMte.I agree'to accept the adii'efioiisi <br /> charges for the disposal of this waste If the Information'(have provided about this waste Is Incorrect <br /> 0 d3)Thls'waste:Is trod�s�"tank vahkh collects waste oil from household"do-It-yourself"(DIY)and/or coridllldnatt'exen;ptsmall c�usntiry 0atoi•�irESIZG)sotrrc s.To the treat"ot my <br /> knowledge,the d , it6 :`' ` <br /> ly olitontitlnerd•!n my DIY/CESQG colt©ctFon tank!s soley from DIY ariNot CEStO 1 halo not Intjce�d.th�sN ate oil wtt!`i:any othei hafardoas laasle or waste ell <br /> from giber sources:I ig.0e to aecept the additional char0es.for'disposal of this waste If the information 1 have Ofovlde�abotrt'th�s`virtste is`lt�cotrect' ` <br /> (All generators)customers-MUST rehdlhe followirigftdxt . <br /> Lcertl that-I have a r e . <br /> W program In place to reduce the volume and toxicity of waste generated to the degree'(have determined to be�acotra'mlcalty practicabie and that'(have selected the <br /> practicable-method of treatment,storage,or disposal currently available to me which minhnizes the present and future threattq human life and•llie anvlronment. <br /> This individual signing In ttio space set forth-below on behalf of customer represents and'warrsnts that he/she has the atiltierityto'blad ciestorown,that the forgoinngg descriptions of waste'-i. <br /> and materials are true and accurate as pacitaged,marked,and labeled,are ready for transportatlow1h 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 Orders with an associated hazardous waste manifest(either alta specific or consolidated)are subject to an EPA Fee.These fees over the EPA'pass-through fee and administration <br /> of the eManlfest program.These fees vary based on Manifest type.Applicable fees will appear on your billing invoice. <br /> us Omer Si re Date �; Driver Signature Date <br /> kla� N I u <br /> Print Name Print nrivor Nnmm <br />