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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO, <br /> FOR ACCOUNTING CALL: N3119143 <br /> 562-231-1550 OWORLDOIL <br /> ENVIRONMENTAL SERVICESr„ <br /> s 7300 CHEVRON WAY,DIXON.CA 95620 <br /> " GU7.MAN'S AUTO REPAIR GUZW3 1-800-727-2879 <br /> P '1037 W YOSEMITE AVE WWW.WORLDOILCORP.COM '1037 W YOSEMITE AVF <br /> E TRANSPORTER EPA#CA0028277036 <br /> T MANTECA. CA M37 MANTECA, CA 95337 <br /> IXVAI 239-2819 (209) 239-2819 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> Gur_003 f IOUTF :^ CARLOS <br /> r~ <br /> DATE REQUIRED DATE ENTERED NEXT SERVItETIATE CUSTOMER EPA# BILL of LADINGI MANIFEST# <br /> 12131/2019 CAL000338349 <br /> PART# DESCRIPTION QTY UNIT PRICE OTY PIU TOTAL <br /> USEC OIC.; MIXED OILS 330 $0.00 $0.00 <br /> USED OIL SERVICE CHARGE I sf35 00 <br /> "CI,•ST MER GALLED IN FOR WASTE OIL PICK1JP"jJHUFf lil;tg) l�a4FCt1* _..._ TOTAL PAGE© DRIVE: <br /> CASH REC'D: CHECK cj <br /> wAsIrE DIS OS I ORMATIO <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NUN-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: ASaURY FIWRO1dMENTAL SERVICESXERE-S, S G2tl MORDAN RD,CERES_.s ±�z3r�&�_?t19�5cSi_79�5,CAt_04101236901 <br /> ALTERNATE TSDF: <br /> crnn.S�raets— Acoaunt Managbr. Sam Read <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: 9SC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below 1 hereby certify that: <br /> f (Waste oil generator/customer MIDST check ONE of the fallowing three boxes) <br /> Y"1)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 PCBs.I have <br /> compiled with the requirements of the applicable California used oil management regulations to determine this Is true.t agree to accept the additional Charges for the disposal of this waste It <br /> the Information I have provided about this waste Is incorrect <br /> d #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,and the waste does not contain any PCBs.i <br /> have provided proper documentation to World Oil Environmental Servlcea to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste If the Information I havo provided about this waste is Incorrect <br /> e3)This waste is from a tank which collects waste oil from household"dolt-yourself'(DIY)andlor conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank is soley from DIY andfor CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> 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 <br /> (All generators/customers MUST read the fallowing text <br /> 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 1 have satected the <br /> pracllcable method of treafinem,storage,or disposal currently available to ma which minimises the present and future threat to human life and the environment. <br /> This Individual signing In the space set forth below on behalf of customer ropresonls and warrants that hefshe has the aulhorlty to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged.marked,and labeled,are ready for Iran sportatIon In accordance with aPpIlcahle 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 /> Servlce Orders with an associated hazardous waste manlfesl(either site specific or consolidated)are subject to an EPA Fee, These leas cover the EPA pass-through fee and administration <br /> of the eManifest program. These teas vary based on Manifest type. Applicable fees will appeA[on your billing invoice <br /> Customer Signature Date Driver Signature Date <br /> 1L 31 -el <br /> 'Print Name Print Driver Name - <br />