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} FOR SERVICE CALL: \ SERVICE 0R%FR FORM N0,WOES004.-B 8/18 DIXON OFFICE ( ? ASUf�Y� NUIRNMEN°TAL S RVICES, UA sI=RVIce ORDER No. 1-800-727-2879 I FOR ACCOUNTING CALL: 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES,, H 7300 CHEVRON WAY, DIXON,CA 95620 IFIRE p i 0NF-: #356612 UES .I 111 C I iOI�iT..FIRE E P P 940 f'.'d,.rr;:f N!"4"f�AL i�`i E WWW.WORLDOILCORP.,COM 1�6 MAIN STRE-t„T, SUITE 420 E TRANSPORTER EPA#CA101028277036 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES FIR.C�6Is ".OU, TrR 1#d I�i/�f��i�l. ��wv1�lEDIJ€I I 114 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# SILL of LADING/MANIFEST# 'I 11,2212018 11114/20 18 CALDOW,70390 PART# DESCRIPTION OTY UNIT PRICE QTY P/U TOTAL WO Wit:.`, (A k�l I¢UftFP �i Ir�rl:d"�F � •c) USE X]tw;)Il f Rtll Liv:►OIL, �5 (31PEN 74PM SAC 7..OPM SUN 9,6PM BATCH TOTAL CASH REC'D; CHECK WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STAT E CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF' 1 t,o S,- S, " . A,,CERES,, S Y,7 (209)5411825'6 f DRUMS P/U: EMPTY DRUMS: FACILITY: CSC 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): �F#1)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 PCBs.I have complied with the requirements of 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 0 #21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 7,000 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 if the information I have provided about this waste is Incorrect Q #3)Thiswaste 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 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 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 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 to me which minimizes the present and future threat to human life and the environment. This Individual-signing 1the 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 materiajs are trye an 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`C,onditlons on the reverse side of this Service Order. Service OrdBfs with an;asspclate hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees co r e EPA pass-through fee and administration of the eManif st pro �d�p hese�e�vary,based on Manifest type. Applicable fees will appear on your billing invoice. Customer Signatu� Date Driver Signatur ate Print Name Print Driver e