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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO 1-800-727-2879 N2752706 5FOR6 -3CCOUO TING CALL: GWORLDOIL .o Charge ENVIRONMENTAL SERVICES. S 7300 CHEVRON WAY DIXON CA 95620 CERTIFIED COLLISION CENTER 1-aooa2i-2x79 CERTIFIED COLLISION CENTER P 7710 MURRAY DRIVE 4171 INDUSTRIAL WAY P WWW.WORLDOILCORP.COM fl STOCKTON,CA 95210 TRANSPORTER EPA#CAD028277036 TRACY,CA 95304 T (209)478-9971 (209)836-4893 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES avejazque 400 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of1ADING/MANIFEST# 01�1�91oC�Zz � P T Rff49RI QT UNIT PRICE QTY P/U TOTAL._ �D p)easo pl kup as sacn as passible BATCH# PAGED DRN TOTAL CASH RECD: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE 133 OTHER: DESIGNATED TSDF• ASBURY ENVIRONMENTAL SERVICES+CERES,192D MORGAN RD.,CERES,CA SS368(209)SMA826,CA1:000393800 ALTERNATE TSDF• Cross Streets, • AccountManager:TOM A11rIt DRUMS P/U: EMPTY DRUMS: FACILITY: BSC PENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) B signingbelow)horebyeartlfythat, (Waste ail generator/customer MUST check ONE of the following three boxes) ' 01)1 bayonet mixed any at tho wool*dascrlbod above with any other hazardaus wants,the total halide content to LESS than 1,000 ppm,and the waste does not contaln nrry Me.I hove compiled with the requirements of the appllcabla California used all management regulations to dotormino this to true.i agree to aceopt the addlilonal charges foriho disposal of this waste tt the Information I have provided about this waste is Incorrect Q A21 have not mixed any of the waste described above with any other hazardous waste,the total halldo content Is GREATER than 1,0110 ppm,and the waste does not contain any Kits.I have provided proper documentation to World Oil Envlroamontal Services to rebut the prosumpuen that this waslowan mixed with other hazardous waste.I agree to accept the additional ehsrgos for the disposal at this waste It the Information I have provided about thin wait*to Incorrect 0 /3)Titin woato is from a tank which colleata waste all from household"dwlt•yoataolf•(DIY)and/or conditionally exempt amail quantity generator(CESGO)sources.To lho boat a1 my knowladge,the only waste oil contained In my VIY/CESOO Collection tank to soloy from DIY andfor CESOG sources.I have not mixed this waste ail with Wry other hazardous waste of waste oil from other sources.I agree to accept the additional Chorgoe for disposal of this waste If the Information I have provided about thle wants Is Incorrect (All generators/customers MUST read the following text 1 cortlfy that I have a program In place to reduce the vorumo and toxicity of waste generated to the degree 1 have determined to be oconomlcally procticable and that I have selected the practicable method of treatment,storage,or disposal currently avallablo to me which minimizes the present and future throat to human life and the environment. Wo Individual signing In the spoca sat forth below on behalf of customer represents and warrants that he/she has tgrintnriverName ind c tomer,that tho rorgoingg description of waste and matetlal*a air ue acoumto as packaged,marked,and labeled,are ready for transportation In accordance wtoe fadem1 mgulatlans,end that customer shell abide by Iho Standard TNma ad Condigono an the rovafoo oldo of this Service Order. Service Ordure with n oneoeiatad hargrdoua waste manifesi(oithcc alto npeelflc or consolidated)are subject to'" e ver the EPA pass-through roe and adm{nlsuallon of the*A st pr gram.These lose very based an Manifest type Applicable lees will splicer on your b grnvol _ 2Customer Signature Date ature Date Print Name er Name