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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-80D-727-2879 <br /> 11313011 <br /> FOR ACCOUNTING CALL: wor&D OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> S 7300 CHEVRON WAY,DIXON.CA 95820 <br /> " GUZMAN'S AUTO REPAIR - GUZD03 1-84a-727.2879 <br /> P1)137 W YOSEMITE AVE 1037 IN YOSEMITE AVE <br /> P WWW.WORLDOILCORP.COM <br /> F TRANSPORTER EPA CA0028277D36 <br /> T MAi�ITECh, CAE MAI'ITECR,CIS 95337 <br /> a 12M) 2.39-2.819 I20912.39-2819 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 4U_0u :1L�� hinafusa <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 11131-102-0 C AL00044014;i <br /> PART* DESCRIPTION QTY UNIT PRICE OTY PIU TOTAL <br /> OF USED METAL OIL AND GASGt.#iVF F#ETERS 2 $IS5 00 $110.00 <br /> OFDR CIL FILTER DRUM REPLACEMENT, NO CHARGE 2. : ' � $0.00 <br /> 13ATCI <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 WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: fKifi-RCRi+H ZA?30(:lfSv4ASTE SOLID fFILTERSCONTAIM,INCOltl _STATE CODE 223 _ <br /> DESIGNATED TSDF: AMERICAN VALLEY WASTE OIL,521 INDUSTRIAL DANE,SUITE M,LIV#NGSTON,GA 95334, (8417)732-4645. CALOtOGM 511'! <br /> ALTERNATE TSDF: <br /> LJ l.rGt.1 silet tai Aocouw Manik17Pr SSm Read <br /> DRUMS P/U:--�-111 EMPTY DRUMS: FACILITY: BSC_ <br /> GENERATOR WASTE CERTIFICATION (PLEASE-CHECK THE APPROPRIATE BOX) <br /> By slgnrng below;hereby certlty[het! <br /> (Waste oil generator/customer MUST check ONE of the fallowing three boxes) <br /> 0 i1)!have nal mixed any bf the waste described above with any other hazardous waste,the Total halide content la LESS than 4,000 ppm,and the waste does not contain any PCBs.I have <br /> cornpfled with the requirements of the applicable California used all menagernenf regulations to derfamilne This Is true.I agree to accept The addltlonal charges for the disposal of this waste if <br /> the Information I have provided about this waste is Incorrect <br /> C 02 1 have not mixed any of the waste described above with any other hazardous waste.The total halide content I s GIFT E ATER than 1,000 ppm,and the waste does not contain any PCBs-I <br /> have provided proper decumanfallon to wand Oil Environmental Services to rebut the presumption Ihal thea waste was mixed with other hazardous waste-I agree to ecczpl the additional <br /> cnhargas for the disposal of this waste If the information I have provided a bout this waste is Incorrect <br /> yf 831 This waste Is from a tank which collects waste oil from houaen6ld'-dO-Il-yourself"(DIY)andlor Conditionally exempt small quantity generator(CESGG)sources.To the best of my <br /> knowledge,Ilse only waste oil contained In my DIY/CESOG Collection tank Is"ley I rom MY andrar CESOG sources.I have not mixed th Is waste oil with any other hazardous waste or waste oil <br /> from other sources.I spree to accept file additional charges for disposal of this wasle If the Informatlon I have provided about lhls waste is Inconel <br /> (All generators/customers MUST read the following text <br /> F certily,that I have a program In place to reduce the volume 811.0 toxicity of waste genes wed to the degree I have determined lobe economically practicable and that t have selected the <br /> praLlicabie msthed o treatment.storage.Or disp6 sal turrentiy available to me which Nnlmize5 the present and future th real to human Ilie and the environment. <br /> ThIs individual sign Ing I n the space set forth bolow on behalf of cuslomer represents and warrants that he/she has Tha authority to bind cuatarner,1111611 the lorgding descflpll ons of waste <br /> and materials are True and accurate as packaged,marked,and labeled,ore ready far transportation in accordance with applicable state and laderal regulations,and that Customer shell abide <br /> by the Standard Terms and Conditions on the reverse side Of this Sere Ice Order. <br /> Service Orders with an as Ialed hazardous waste manifest(either site specific or consolidstedl ars subject to an EPA Fee.These fees cover the EPA pass-through fee and adminisirallon <br /> of the eldest est program. hre fees vary based on Manifest type.Applicable fees will appear on your billing Invoice- - - <br /> Customer Signata Date Dr#ver Signature Date <br /> Print Name Print Driver Name <br />