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FOR SERVICE CALL : SERVICE ORDER FORM N0. WOES004 - B ( 8/18) <br /> DIXONFICE ASBURY ENVIRONMENTAL <br /> NMENTAL SERVICES DBA <br /> 1 - 800-00=727- 2879 f SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL : N3183211 <br /> fir WORLD OIL <br /> 562- 231 � 1550 <br /> h <br /> ENVIRONMENTAL SERVICES : , <br /> s <br /> " _I RAG'Y TOY�� TA fJgf� Tt i ht IGLCE R(7 7300 CHEVRON WAY, DIXON , CA 95620 <br /> P1 .800-727-2879 <br /> P :'f4sJ NORTH NAGL .EE RC' AD 2895 NORTH NA GLEE ROAD <br /> E WWW.WORLDOILCORP. COM <br /> D I Rp �:Y , (;,a �J� 304 TRANSPORTER EPA # CADD28277036 TRACY, CA 953 . d <br /> T <br /> 0 G'09 ) 834 - 1111 ( 209, 834 - 1111 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> TRACI;" r✓ 10LIS700•IAItJ CER 86 (sE? Ir� tJ II1f, SC} JED! A . IEJ - 1 <br /> IF <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # <br /> 4: Oil CAR0012il <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> al USED NIFTA �• OIL AHE.1 GAS011 FILTERS lo . 0c u �t:a <br /> 4 C1R OIL FlLYI` 1 ' f?I? LINi lil_PIACEMENT • NO CHAS t <br /> rri. 7. Mil E COWES OF SeRvIcli ORDER Q SITE11 Only I"ve 3 realacr+nefttG :titan l pr Ing ot'• fnrPrs ". r W. rk og rm or <br /> TOTAL <br /> CASH REC ' D : CHECK # <br /> WASTE DISPOSAL INFORMATION <br /> NON- RCRA HAZARDOUS WASTE, LIQUID ( USED OILIMIXED OILS) STATE CODE 221 <br /> NON- RCRA HAZARDOUS WASTEr LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> Oil OTHER : t . a r r 1 F r can r . " <br /> DESIGNATED TSDF: <br /> AMtiRICAN 1/A), LFY tIVASYE OIL, 521 INDUSTRIAL DRIVE SUITE Nd LNgNGSTON c�+ 4F5334 iWo) Ta2 •�i � t � , CAL017dW -+� )u <br /> ALTERNATE TSDF : fLc,�ut,i &1arugoir. Sam Read <br /> t---f �b5 WAS FIZ�F' pr REPLC:NI aT:� „�OIL TANKS CHECK BOTH l . ro nuc <br /> DRUMS P/U : EMPTY DRUMS : FACILITY: BSC <br /> Wilson <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 y1 ) I have not mixed any of the 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 Peas. I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true. I agree to accept the addluenal 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, ahave nd the waste does not contain any PCBs. I <br /> charges provided <br /> roper documentation <br /> his atiion o therldo it oiI Environmental a presided about rebut <br /> the wasteIspresumption <br /> nIncorrect that this waste was mixed with other hazardous waste. I agree to accept the additional <br /> dispo <br /> Y3) This waste Is from stank which collects waste oil from household "do•Il•yourself" (DIY) andfor conditionally exempt small quantity generator (CESQG) sources. To the beat of my <br /> knowledge, <br /> ledge , the <br /> only <br /> agstt a to accept contained <br /> dein my(onal charges for disposal <br /> o}ithls Iwasto If ey fromDeylnfamagon Qheve pro Ided about Ihts wasG sources, I have not mixed tte Isis wncorrecaste oil wlth any other hazardous waste or waste all <br /> cel <br /> (All generators/ Customers MUST read the following text <br /> 1 certify that I have a program In place to reduce the volume and toxicity of weaie generated to the degree I have determined to be economically practicable and that I have selected the <br /> pracCnablo method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> Thts 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 Standard true <br /> as d Conditions nd accul'818 as on her verse side ofthisService Orders for transportation in accire ordance with applicable state and federal regulations, and that customer shall abide <br /> Service Orders with an associated hazardous <br /> Manifest ifest (either typed site specific <br /> eb of is or will appeal on your bilin gllnvolce.o an A Fee. Theses cover the EPA paas•Ihrough tee end administration <br /> of the eManifest program, These fees vary �ry -y , _ !za/ l <br /> ?V Ads <br /> X -= rl Driver Signatur Date <br /> Customer Signature Date <br /> 1 <br /> Print Driver Name <br />