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t FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: LO ; 104 1. 562-231-1550 WORLD O I L ENVIRONMENTAL SERVICES, S 7300 CHEVRON WAY, DIXON,CA 95620 H OUZMAPTS Al ITO REPAIR UUZW:� 1-800a27-2879 P 1031 W 110S Atli•I !1VLE WWW.WORLQOILCORP.CbM 1037 W YOSEIVITF AVE ETRANSPORTER EPA#CA0028277036 MAUTECA, CA O°as" ��yy o [''1�N1 ��D•�8t41 I�'(1�i :;��+-;Etta CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES puno DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINGI MANIFEST# req y r PART# DESCRIPTION QTY UNIT PRICE QTY PAI TOTAL I.'i WrLTT# ;L fi ':d. 31.,t.1Ti: V Ian) 1 0 fir, TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: }Irl i.fJ4!i :;irfirq+!i.r. Acaoitw inigtmq±f tarn i•S�:�il }� DRUMS PfU: EMPTY DRUMS: FACILITY; BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) [] 1111 have not mixed any of the waste described above with any other hazardous waste,the total halide content Iif LESS than 1,000 ppm,and the waste does not contain any PCBs.I have compiled with the rectulrem enls of the eppi+cabie CaiifornIs used oil management reguistions 10 detefmino lhIs I true.l agree to accept the add lf+onaI charges for the disposal of this waste if the Infomration I have provided about this waste Is Incorrect " 121 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 have provided proper documentation to world Oil Environmental Services to rebut the presumption that this weete was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of thIm waste If the information I have provided about thle waste Is incorrect Q 131 This waste Is from a tank which collects waste oil from household"do-It-yourself'(131Y)and/or conditionally exempt small quantity generator(CESGG)sources.To the hest of my knowledge,the only waste oil contained in my DIY/CESGG collection tank Is soley from DIV andlof CESGG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional chargee for disposal of this waste If the Information I have provided about this waste Is Incorrect (All generators(customers MUST read the following text I Certify that t have a program In place to reduce the volume and loxlclty of waste generated to the degree I have determined to be economically pracllcable 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- - i This Indlvldual signing In the sparse set forth below on behalf of customer represents and warrants that he/she ham the authority to bind customer,that the forgoing descrlptlons of waste and materials ore true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations,and that customer shall abide by the Standard Terms and Conditlons on the reverse side of this Service Order. Service Orders with an associated hazardous waste manifest(either alts specific or consolidated)are subject to an EPA Fee,Tera fees cover the EPA pass-through fee and administration of the Wan+fest program. These fees vary bused on Manifest type. Appi his fees will appear on your billing Invoice. .J, Customer Signature Date }'Driver Signature Date _ , ) leI� f Print Name Print Driver Name