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FOR SERVICE CALL: SERVICE ORDER FORM NO-WOES004-8(8/18) <br /> DtXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO, <br /> 1-800-727-2879 <br /> N31473.30 <br /> FOR ACCOUNTING CALL: worIL .1 OIL <br /> 562-231-1550 1( 1,/ <br /> ENVIRONMENTAL SERVICES. <br /> s 7 QO CHEVRON WAY,DIXON,CA 95620 <br /> " /Nt , RICAN PILEDRIVING EQSJIPMEN !h -A 1-800-727-2879 <br /> P 2985 LOOMIS RD WWW.WORLDOILCORP.COM 7032 S 19�iTH ST <br /> E TRANSPORTER EPA# CAD028277036 <br /> STOCKTON, CA 9,9205 KENT, WA 98032 <br /> T <br /> (209) 942-21(36 (209) 942-2166 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AIM E221 ROUTFE '2 VAC Si iloiosa <br /> DATE REQUIRED DATE ENTERED -NEXT SERVICE DATE rCUSTOMEREPA# BILL of LADING!MANIFEST le <br /> 1124/2020 CAL000337612 a26.3(151 J- rJ _7 T T <br /> PART# [))-SCRIP ON - __ OTY UNIT PRICE OTY PIU TOTAL <br /> WO USED OIL/NIXED OILS 220 $0.00 $0.00 <br /> WOSC USED OIL SERVICE CHARGE 1 $65.00 ')QQ $65.00 <br /> 111,Tc 0 E-MAILED FE 112020 TOTAL PAGED DRIVE <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:--- - -- <br /> DESIGNATED <br /> THER: -- -DESIGNATED TSDF: ASPURy- ,r, pr - r% 1- ' <br /> ALTERNATE TSDF: <br /> Accot:nt idanrrer:Sam Batt - <br /> :'rf'4rS <br /> DRUMS P/U: EMPTY DRUMS: FACILITY:_ BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIAT qB6 j= f) <br /> By signing below i hereby cerlify that: r f 1 <br /> (Waste oil generator/customer MUST check ONE of the following three bozesiAN 3 0. 11119 <br /> d1}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 PCUa-1 have <br /> compiled with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the adtlitlonal charg &, <br /> rthe disposal of this waste li - J <br /> the Information I have provided about this waste Is Incorrect <br /> 921 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 eery FCBe�"'�`"•--.�� <br /> have provided proper documentsdan to World Oil Environmental Servleas to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the addRtonal <br /> charges for the disposal of this waste If the Intormatlon I have provided about this waste Is Incorrect <br /> 0 931 This waste Is from a tank which collects waste oil from housetiotd"do-ft-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank Is Soley from DIY and/or CESQG 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 dispoest of this waste if the Information I have provided about this waste is Incorrect <br /> (All generators/customers MUST read the following 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 f have salectad the <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environmertL <br /> This individual signing In the space set forth below en behalf of customer represents and warrents that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as pgckaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulab ons,and that customer shelf abkte <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Or with an associated hazardous Waite manifest(either site specific or consolidated)are subject io an EPA Fee. :,e fees eover the EPA pass-through fee and adminlstratiai:` <br /> of the a t proiram. Theme fees vary based nn Manifest type. Applicable fees will appear on your blhing Invoice, <br /> ust rner Signature Date Dr- ignature Date <br /> r, <br /> _ eQ > <br /> Print Name Print Driver Name <br />