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FOR SERVICE CALL- SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004_g(8/' 1-500-727-2$79 SERVICE ORDER NO. FOR ACCOUNTING CALL: N 3 2'5,3&82 562-231-1550 WORLD OIL, ENVIRONMENTAL SERVICES, S 7300 CHEVRON WAY,DIXON,CA 55620 P ! 1-9-,JV `a T 1 800-727-2879 q WWW.WORLDOILCORP.COM Y953C-4 _ TRANSPORTER EPA#CAD028277036 7 h T 'TRACY, CA 95504 '209,183-3-3881-U 44 -C9) 8.33-388! CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDE: Sn'aIttI1f3G DATE REQUIRED DATE ENTERED NEXT SERVICE BATE CUSTOMER EPA# BILL of LADING/MANIFEST# �C, CA; ,.•,;28 _ - 73 PART# DESCRIPTION _ QTY UNIT PRICE QTY PIU TOTAL 4E lii"ir l.Rt:i TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: I Ni- PAW G. r}I tfi i ra^ � ^Sf>E i / I TCRfi^ ?htT !A3i t f CT r r fSC 772 DESIGNATEDTSDF: AnF1=RICANtfix'_;- -tVAS i Oi; ti_tr`R74` vR' =, �!'?"F 4` C&9`x33 732—W,-, GA_ i�, ALTERNATE TSDF: crosem. DRUMS PIU: ' EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below i hereby certify that., (Was-eoil-gene-ra"W/custO-Mer-UUSrT check ONE of the-following-three boxes),-- #1)1 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 pCBs.I have compiled with the requirements of the applicable Cailforrda used oil management regulations to determine this is true.1 agree to accept the additional charges for the disposat of this waste H the information 1 have provided about this waste is incorrect ❑#2 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,00o ppm,and the waste does not contain any PCBs.I have provided proper documentation to World Oli EnvironmentaF Services to rebut the presumption that this waste was mixed with other hazardous waste.!agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect ©#3)This waste is from a tank which collects waste a"sl from household"do-it-yourself"(DIY)andfor conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my DIYICESCIG collection tank is soley from DIY and/or CESOG sources,I have not mixed this waste Olt with any other hazardous waste or waste oil from other sources_I agree to accept the additional charges for disposal of this waste if the Information i have provided about this waste is incorrect IJL (All generators/customers MUST read the following text 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 Practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. This Individual signing in the cc set forth below on behalf of customer represents and warrants that helshe has the authority to bind customer,that the forgoing descriptions of waste and materials are true and a ate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer f abide by the Standard Ter and di son She reverse side of this Service Order. Service wit a as ted h rdous waste manifest(either site specific or consolidated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration an st p g ary based on Manifest type. Applicable fees will appear on your billing invoice. unto r S' fr DateDriver Signature Date Print Name Print Driver Name