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--•-•--.�.----..-...._....---«.--.:.—�:..--•.�--v.'—� e��:.�-.. .-..�.ey.�.....-.-+-r-..-••--•P--..+.�.+---fug-- J.i�-.�. -- r..—.� ... �. SERVICE ORDER f FOR SERVICE CALL: DIXON OFFICE A$BURY.;ENVIRONMtN TAL'`9r=AVI6ES, DBA FORM NO.WOES004-B (4/17); 1.800-727-2879 '} (' SERVICE ORDER NO.- FOR O. FOR ACCOUNTING CALL: N2C73g 562-231-1550 i WORLDOIL . ENVIRONMENTAL SERVICESr, l s F4 ESTONl�:#-356612 QUE'Sr� t SOURCE M MT'-i !{SIN 7300 CHEVRON WAY,DIXON CA 95620 a z� ��, �. J40 PJ. t"ENTRAL AVE.' 1-800-727-2879 61}',1��AIN TREE ea61{'ids�S.1f� i. a TRACY, y, WWW.WORLDOILCORRCOM �,r f i E 1 f�4A1..+ . .sP'9 a'e�l ",1 - - 1_".�'€.ti;��„�0, X (i��+J34 T � � !�?"I 'Ib TRANSPORTER EPA#CAD028277036 ( /7 ).4 •0004, o i CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# z CONTACT NAME ORDER TAKEN BY HALIDES in 69 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 1� / f ILI( ` �l PART# DESCRIPTION QTY UNITPRICE QTY TOTAL: 7 V 4 s;t.r -*wy a VVI (ISE;1 OIL f MIXED OILS. � 2010 �.aPEN M-P r"^APPA SAT f'•6PM��UN'��raf�M P;A•1'Cf'!� Ei1eativo')`/1/2010: Servioe c)rdem+alvith aselodated haz'svaste manitosts(91tc�f��u�iQltr-ttnac�Iida:,M)arty st0i to an EPA Fes, haat?unuor }�A through fere ane}adoilrtlstratlr(n of the eManifest urogram. Imes vary from -$10 based an Mi sttlPsrsk kyfata. 1Iallrable fees W1 ��L�n CASH RECD: CHECK# WASTE DISPOSAL INFORMATION ' NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 i. NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: , t. C.., k.,_. .'15, >q t AP. yA "U, W .,,, r� •dry. DESIGNATED TSDF: /�LTERNAE TSD 1 „�t0;srx s311`C� Mann r l i DRUMS P/U: .ri EMPTY DRUMS: FACILITY: BSC i I 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) �l#1)1 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 notcontain any PCBs.I have complied with the requireme fts of 4 i the applicable California used oil management regulations to determine this is-true.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect -:) O#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 - have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional.charges for the disposal of this waste,fthe information I have provided about this waste is incorrect 0#3)This waste is from a tank which collects waste oil from household"do-it-yourself"{DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in 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 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 (All generators/customers MUST read the following text and check the associated box:) '1 fl4)If I am a large quantity generator,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 I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment;Or,if Iama-small quantity generator,I ! have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me that I can afford. This individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer,that the forgoing descriptions of waste and materials are true and accurate as package ntSaT ed and labeled,are ready forXranWortation in accordance with applicable state and federal.regulations,and that Customer shall abide and be bound b-he Standard Terms and Conditions on the reverse 52 side of s Servic Order. Customer f ' ature Date Driver M e / Date I. t Print-Name e s ITIame