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FOR4SERVICE CALL ; SERVICE ORDER <br /> DIXQNf OrripE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOL8004 • L3 (8/18 ) <br /> 1 -600-727"2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL ; \ � � /^ N2714918 <br /> 562-231 - 1550 ) � V V R L D O I L <br /> S ENVIRONMENTAL SERVICES ,, <br /> " REEVE TRUCKING REE008 7300 CHEVRON WAY, DIXON, CA 95620 <br /> PP 5050 CARPENTER RD 1 '$00 727-2879 <br /> E WWW.WORLDOILCORP.COM PO BOX 5202 <br /> T <br /> ST4CKTON , CA 95215 TRANSPORTER EISA # CAD028277036 <br /> (209) 940-2623 STOCKTON , CA 95205 <br /> (209) 940-2623 <br /> CUSTOMER # Pt7FfC1T bER #,• ROUTE # TRUCK fi` CONTACT NAME ORDER TAKEN BY HALIDES — <br /> REE008 -3 CER-86 U DAVE SCHEDULED•I <br /> DATE REQUIR D DATE ENTER NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFiST # <br /> 11 /2/2018 #0 5/2018 CALOOb339052Q, e/ '03JJ [ <br /> PART # DESCRIPTION QTY UNIT PRICE QTY PN TOTAL <br /> PWSC PARTS WASHER SERVICE/RENTAL 1 $ 165 , 00 <br /> BATCH <br /> TOTAL <br /> CASH RECD ; CHECK # <br /> WASTE DISPOSAL INFORMATION <br /> NON•RCRA HAZARDOUS WASTE, LIQUID (USED OIIJMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE 135 <br /> OTH "" —NON-RCRAHAZARDOUS-WASTC,-I, IQUID. (011X-WATERI- STAT-E-CODE4.1r1 <br /> bESIGNA'CED TSDFt DC�MtfNO/KERDOQN 2000 NLAMH <br /> ADA ',-rmJT. CO�{�Q�, CA 80x22. 0)537"7100 CA70�9Q13352 <br /> ALTERNATE TSDF. <br /> Cross 5tre Alxount Marta er, Tadd Aurl <br /> DRUMS P/U ; EMPTY DRUMS , FACILITY. BS.0 <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX ) 1� <br /> By algning below I hereby certify that: APPROPRIATE u 13 <br /> REV <br /> ( Waste oil generator/customer MUST check ONE of the f011owln three boxes) <br /> Q #1 ) 1 have not mixed any of the woslo descrlhed above With any olher hazardous waste, the total halide Content Is LESS than 1 ,000 ppm, and hoiveolb rlora nal contain any PCBs, I h vo <br /> compiled wrt�the requirumonls of the appllenhle California used oil management regulatlone to delermfne this Is true, I agree to accept life add It W% lib d es fan lh�kin tiny <br /> ODS, I If to fl <br /> the Information I have provided about this waste Is Incorrect <br /> 0 021 have not mixed any of thb waste described above with any other hazardous wnsto, the total halide content Is GREATER than i ,on0 ppm, and the waste does not contain Any PCBs. I <br /> have provided propor documentation to World 011 Environmcntnl Services to rebut tho prosumpllon that this waste was mixed with other hazardous waste, I agree to accept the additional <br /> cherrien for life dispunpl or this waste If the Information I have provided about title waste Is incorrect <br /> W0,910 In <br /> if <br /> ve 19 waste oil train <br /> k0nupGti igoo, Iho only waan+to Allraanlinllnvd to my viy/ cmw calleetlon lank In coloy Item oly rfnd/o�CF•SOClslouraes�I bil crept Fiat mlll xud Ihlua "it a vlaato off onoratorwith anMCI) <br /> oR errhazarfdolife <br /> s waste or waste all <br /> from <br /> m other anurces, I nf,roo 1l0 uceepl Ilia riddillohal chnrgea for dinpaanl of titin two [ o If Ilio Information I have provided about this wssin Is Incorrect <br /> (All generators/ customers MUST read the following text <br /> I certify that I havn a program in ptoce to lo)luao the volume and loxfclly of Waste portended to the dngrce I hove determined to be noonornlcully practicable and that I have selected the <br /> Practicable method of Irenlmonl, Alerugo, or disposal currently nvalinble to nuc Which mlnlmlzeo the pruncnt and future lhreal to human life and the environment, g <br /> Tills <br /> Individual <br /> aroltrp tnnd accurate ce en packngth ed below on <br /> anld inn led,erre re ready for frarnsp nation In acuordnr line <br /> with oppilenhlo olein o �nfoder�ltrenu olionn c nd jf ntcruslinp waste abide <br /> by the Slund;nd Terms find Condlltona on the rovarne nide of Itch Snrvicu older, <br /> Servleu Orden, with an uasoeinle hazardous waste nlnnUast (either site Specific or canaolldnted) are subject to an EPA Fee, Ther e , r. Of • C A 1 au• through tea and adminlelralleh <br /> — I drklnnlM.r I,Pragr , • Thos lees very basad on Manllest type, Appllcnblo fees wit[ appear on your billing Invoice, <br /> , u mer i�nature Date Driver Ill ro Datc <br /> h,E�Print Name Print Driver Name <br />