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FOR SERVICE CALL: SERVICE ORDER FORM NO.VVOES004-B M/18} <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-21179 SERVICE ORDER NO. <br /> FOR ACNG CALL: WoR�D OIL <br /> 5&2-23t-1550-1550 <br /> ENVIRONMENTAL SERVICES. <br /> w 7300 CHEVRON WAY,DIXON,CA 9,620 <br /> P 1-800.727-2870 <br /> r WWW.WORLDOILCORP.COM <br /> F' TRANSPORTER EPA 9 CADD20277035 <br /> :sA[;HA}AL-1i1Ci (:4fa`x7fyt <br /> CUSTOMER i PURCHASE ORDER 4 ROUTE k I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> I I <br /> o I�/ <br /> DATE REQUERED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA a BILL of L.ADINCd MANIFEST 0 <br /> PART p DESCRIPTION OTY UNIT PRICE OTY PIU TOTAL <br /> TOTAL <br /> CASH RECD: CHECK+[_ <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID[USED OIUMIXED OILS] STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID[ETHYLENE GLYCOL SOLUTIONS] STATE CODE <br /> OTHER: =r-rr,:ifs>�r•i x x I'.i�::.,:L `..ti�L:41t i L�r�,�_ufii=Llllh}:���iL;STATE CQnF 223_ <br /> DESIGNATEO TSDF: RII[ERICRF�'inLLEY 4I`ZAST 91L,9_'-1 INDUST7iFA!DR tr/,LIVIM'3S1-OF4,CA iZllt-X49.493•?dF11.C+�LOU(�l-ISSII'•• <br /> ALTERNATE TSDF: <br /> jv Tt)nK rubti.nxs[feta.Ext-iRE L Ammirit MWOW Um Read <br /> DRUMS P/IJ: / __ EMPTY DRUMS: FACILITY: EISC <br /> GENERATOR WASTE CERTIFICATION(PLEASE.CHECK THE APPROPRIATE BOX) <br /> Fay signing below 1 hereby cedlfy[net: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Gal)1 haven nDl mixed¢ny of the waste cl.crllyd above with dny other nazardvu..osis.my tete[nrthde contval is LE$S then 1.000 ppm..nd the—to does not cvnlaln any PC6a.1 nave <br /> edmplled with Ine Te4,rlrvm.ate. in appllcebln Californre used v111._pgedlen[reg ulallone Io tlalerminv link.Is tru..l aorw[o eccepi the addi[lonel chargaa far the tliepose7 of Ihld.pale It <br /> tho lnlovmallon 1 here,,p Ido I about thea waste le Incorrect <br /> Q <br /> '2'have rad/-I..d any of the.stile cl a lbad ebvve wall¢n,olnor n.—doue..rile[ne[alai halide cunlent 1.GREATER In-voaa Ppm,and Ine waste da.a no[ton{ain tiny K131 I <br /> hayC prgY tled Proper yocumanlativn l0 YYvnd DI E.wron menial SOry lcav rP cubo[ihv prviump an Thal this wailo was m[ied with older haxardc"w.ate.I agree Iv ac"I t Ins addlnonal <br /> ,:harges I—lav dl spoval vl Inks"Ave II the Inco nneuon 1 hate provided about WINwavte a Incur 11 <br /> 151 Th--weals la Irum a lank welch col lepe weal.D,1 hem by uaehd Id"dtrH yvuryel l'jolt')a11d[ur pvnEnbna toy-;,j.—II qua duly Qeaerelo,IGESpo]_.reef To Ih.best of my <br /> Nnowledg..the only'nests ell cvnl¢Ined to my DIT!CESOG collation I.ah to avlvy From DIY pn dior CESOG sources I nave vol mi.ed lhla waste oil with any other IUMUCIGI k walla ar.vatile 011 <br /> frdrtl Oth.r.vurce.I eq tae I.-cc epi the addllly nal Chargee for dl novae[vl this wevle rl the InI�r lin I have pr­]addeM ul Ihi...U 1.i1 Ipcarrecl <br /> (All generators/customers MUST read the following text <br /> C.r'bfw'{het I navy•pfvgr.lrl In place Iv redueti In.;ol ume and lo.1Cnw v[waaty gerfarated{ the degree i nave e¢lmm bled to-be ecnnvmkcally prec.cehle antl Ih.I 1 have aslect.A Ih6 <br /> pcbcable alai,,oci M L1.6"erll•atarege,or dl.Pos [u rfen[ry evmlahlq 10 nw watch minimtrea Ine present and funic.th+eal to nomad Ilf.and 1ha enr[radmenl. <br /> This 1ndlvW.e1 el9nlnp In Ine apace del Ialtn nelow on benall of Cue[om reproeente and w.n.n11 Ihq{hvldry hie[he au7hvrify lu alrtd CupemM,Idol Iha IeryvlrVq deacrtpLans vl wally <br /> and maidrlela are fru.and aCc urele.a pach.ysd.merlra4.and[abated.•*v ready Ivr[r.nepvrtallvn In a[cordanu w1[n epphceble stale end Federal r.pulalloae,antl Incl cualwnar anal/anlde <br /> by aha to adn[d Terms ache CondllVona on tFly f.vsrae vide vl1 hie Sarvrce Qrder <br /> e Ordvaa with an a—aged naaardaua weala madlFeai lellnor Ocie apecllk or con anlidatn1Ora au bloc+[v an EF'a f.e.Tease In.a evm Iha EPR paal•DuoupM1 lee and.dminl.lrerlen <br /> vlaani}eal pro9nm Theav Sear very Ilaaad od senile..lyp..App.,cii.i.M..ells appae.on yaur-IIk [n- <br /> ��I1�'�R�OC�A >J��l <br /> Cusenmer <br /> Date Driver Signature <br /> Signature Det <br /> /QL <br /> Print Driver Name <br />