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<br /> FOR SERVICE:CALL: SERVICE ORDER
<br /> DIXON OFFICE ASBUR.Y ENVIRONMENTAL_ SERVICES, DBA FORM NO.WOES004-B (1/17)
<br /> 7 '%SBllRY Wob50 SERVICE ORDERNO;'
<br /> Pu4ACCOUNTING CALL: WOUIY 0
<br /> 562-2314550
<br /> 1550 N7.4003fl�
<br /> AF 125
<br /> WORLD OIL
<br /> ENVIRO-NMENTAL SERVICES,.
<br /> S STOCKT'QI\I DODGE INC 7300 CHEVRON WAY,OIxOI CA 95620 .
<br /> I t-800-?-ASBURY„
<br /> P 3333 AUT+=J t'<ENTER CIRCLE Pn 130X.$009. .
<br /> P WWW,WORLDOILCOFIRCOM
<br /> E , . . - f
<br /> ° STf.)CKTQN,G&95212 TRANSPORTER`EPA1 CAD028277036 STOCI4TONr CA 95208
<br /> o (209 477-36e8,
<br /> (21A.477-36.68
<br /> CUSTOMER# ` PU CH CfRDER.k ROUTE-# UCK CONTACT NAME ORDER TAKEN SY . FiALiDa 5. .
<br /> ST0627 124 ,SCHEDULED-1 f
<br /> DME REQUIRED DATE ENTERED NEXT ST RVICE DATE -CUSTOMER EPA# BILL of LADINGINIANIFEST 4
<br /> 7l]:1241.7. 7/122017 CAD9$19E378g0
<br /> �l
<br /> PART 4 DESCRIPTION QTY UNITPRICE- QTY P/U 'TOTAL
<br /> wo USED OIL/MIXED'OILS -- s0:00 $0.00
<br /> `WOSC USED OIL SERVICCHr PRP 1 $80.0.0 > . $80.00
<br /> BATCH
<br /> Gror 5trorst TOTAL.
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<br /> CASIiREC6-..., _ C1-IECk'# ': " ,}
<br /> WASTE DISPOSAL JNFORM VION• 0
<br /> x NON•RCRA HA2AREWS WASTE;LIQUID(USED ouL m b OII S) ;FATE CODE 271
<br /> NCN mRCRA FIPi2AR`j0UJ WA5TI=s LIQUID(ETHYLENE GLYCOL SOLUTIONS?. STAI'E'CODE . .!.•.
<br /> OT17FTif: 1t —_
<br /> X GFSIGNATFt1T5DF:_A� I 7Nl46CfiTAESEfi�ff r $� AR3i�$I FkFt 2�E9; 8 3 9'[�E91 )5dt�i$' I f:0G3$'3C8a i
<br /> ALTERNATETSDF: – --•_�` _ _ �_ --
<br /> DRUMS PIU: ' EMPTY DRUMS,; FACILITY: BSC'
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX)` '
<br /> fay s,nrong hdn•rr I hereby eertdy.that: - -
<br /> (W;a3t�ail generator/customer MUST check ONE of the following three.boxes}. .`.,.
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<br /> in my DIY/CESC.,collection lank is coley from Dly and/or.CESQG sources.)have not mkc-d this wa!lr ml v,ith any or]ier hi:ardousivaslrorswile nil from oTher snurces l agrcr to xcrpt the addllional charq_L•t fnr dl:pw.il
<br /> -"dlihhwa+ta]flFsc✓slorrnttivnitut4fieavWed:rS»utkhkiysupi5�ksceraet
<br /> (Ail gerl'ergors/customers MUST read the following text.and-check the associated hox.)
<br /> 41,11114 ami lugaquandtygeneramr.kwlfythat lhevatum+l and lcxielty of,vaae.gr:nermled to the degree l L•ave•dowinIned to h,econorniallypracticablo and that l have -
<br /> sOKwdshlrpracdrablemethodo f ve.+smun4st"gi,mdls";levrrunry avalhsr,luso.nx+rl+kh rrilni*N7us thea pie, future thu:at sa htunan Iifc and the u,vbonmrnt Or,'If I ain a:mall quamity qunt•mtor,I
<br /> xyo m,de,s gaol faith rffurt tp�nilnlm}=V.rttywapb�nnri5larr ami edlr,cl the tiro wa5u mand9rrrlr;m rrllphad trial is asfallahle to me)hal,l C�rvalford.'
<br /> Thii WAshulslgn]ngln lheepacespf farlh bcia+v-ern lrChalI151CdslmAar repreienis anti warrantti.tlu[helsPte h,a:the aurhorfry to hlisd Cuclomec oisnhc furgoing da.cdphoos of.vaae and materials me nueandaccurlw
<br /> az p.xD.agcd,marl,.xi and L,60l.d,arc w;,dy for Iranspnrl_allon in xcmdancr v:ilh appl¢ablr spate and(Moral r."dulatiein,mvf d6t Cil;hm:cr shall abide and he bound by the Standard Terms and Conditions on the tevere
<br /> sido of this Service Order.
<br /> C st rnerSlnatur Date / rivtar.5tgnalilr c7tf:
<br /> Print•Name Pri fit Drivers Name
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