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FOR SERVICE CAL.' V -SERVICE ORDER FORM NO,WOES004-B(8/18) DIXON OFFICE AS.)3UPY`ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER N0 FOR ACCOUNTING CALL: N2741421562-231•-'1.550 WORLDOW ENVIRONMENTAL SERVICES.M S 7300 CHEVRON WAY,DIXON,CA 95620 H STOCKrON DODGE_ INC 1-8ae=727= I} 2e7s P .9333 ALITO CE:NTf R:GlF2CLE WWW.WORLDO.ILCORI?COM PO R� 8W9 Y E TRANSPORTER EPA•#•CAD028277036 ° STOCKT(A, CA 95212 SI'OCKTUN, CA a520K T (2.09) 477-W766 (209) 477-36CRi CUSTOMER.# PURCHASE ORDER# ROUTE# TRUCK# CtONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE. .CUSTOMER EPA# BILL of LADING/MANIFEST(I# . 7 .t 81� 1 t5 � D9.8'19B 8iJ• V 1�� 1 �,, Z 1 �J P 7 QTY. UNIT P C QTYAP/ TQ, ENI$ ' E- 1ANIFES7FPA Fl-E.A:ADMIN- SiTE'SPECIFIG.MANfFE. 1 '. , $10.00 slo.la�' �'scff i. 55:aAiLLoN $52„00 TOTAL CASH RECD:r CHEGK,. WASTE DISPOSAL INFORMATION i+QNIFICRA HAzARDDUS VVAS..TE,'LIQUID(USE0,OI.LI IxED.OILS). STATC CODE_2 1 . NOSE-RCRA HAZARDOUS WASTE,LIQUID 4ETFIYLt NIE GLYCOL SOLUTIONS) STATE,CODE OTHER: .rn;e n•M DESIGNATED TSDF: ffALTERNATE'TSDF: �wt S'' -- _Crotr'e�: Get slgnatura Rant easy'. -- _---- - ?�cCawlt�sitapr fo Ai t” DRUMS P/U:—_11- EMPTY DRUMS: FACILITY:• BSC GENERATOR W4STECERTIFICATION (PLEAS8.CHECK THE APPROPRIATE 80X)- . By.slgning below I hereby certify that: (Waste oil generator/customer MUST.check ONE of the following three boxes) 1)$have not mlaod any at Ihfl wastd rfancribod abovo with nny other hazardous waste,the total halldo conlent Is LESS than 1,0-00 ppm,and the waaln sops not contnln any PCBs,.I havb .. complied with the roqulrohionts of the oppllcahlo Callforpr'la used all manogemnl rebulatlons to dole mine this is tr11o.I oyree to accepl the nddltlonml charges for Ino disposal of 11119 waato II Dw Infotlnalfon I have provldatf nboul No.wnstu Is Incorrect U r•21 have not mlxodany of the*to tedanvrlbad abovo with any other nelardous was It,Iha total Iinllda content in GREATER Ihit n 1.000 ppm,and Cho waste docs not contafn any PCE&I have provided 6fbpas documentallon fo.World 04Enybonmentnt Servlcda[d rebut[ho presumption that this waste was(nixed with Other hotadou7 waele.I agree to accept 16 oddh(1od'al chnigoa for the dioposol of this wooto II the Information t hnvo provIdej alwut thiswoato 161ncorfaCl 0 13)thla waste is from a tank WIsle;h ullfeet4 waste of[from hoosohold"do-It-yoursalt"(OM and/or cblldl Clonally oxampl small gvahfit y gentirmoi{CESCG)sources,To the be i of my knowledge,Ibb•Cnty wa ao nit coMiolned In my DlY1 CESOG collattlon tank lo'soley.from MY thdror 0E800 sourcoo,I have not mixed Itil3wfrsla oil with any othot he rdeua wanla or wasto.oll boat other so'u;;te I agree td,aacepl Ill.rxldlllorial chargos fordispo"' I of this Waata If the lnformnllon f Itava provldod obout t4ltt wlizto Is fneorrart _ ,- (AII generators/customers MUST read-the following text I certify that I have n pragrorn In placo to reduce the volume find tpxielly of wanle generated to the degree I have ckwi-mined to be oaonamicalty practicable and that t hnvo selacted 1110 practicable method of treatment,storage,or disposal currently available to me which minimizes the presont and future threat to human life and tho environment. This Indlvlduaf signing In the apace tat IOrih below on bohall of tuetafner rbprosonts and wsrranis that h"I'a hae Iho authority to bled slamar,(hot the lorgaing descrlptlons pf waste and inn lw tale are true and occurale nn packs and,itlorked,and Inbu lod,era ready for trat,apartet ion in mcaordunca vriIh appllcabla.s it, rederN regular Ion a,arid that customer shalt abide oue and Condillona on rho raverso t1do Of this Sorvice Order. aaaaelntad hazardous wnole mohltest(etthcr sltenpeclllc or consolhdalod).are subject to an EPA Kee. Th a to r A a -th Ugh fee and administration ra, •these lean vary beood an Alonlffum type.JAppplicobleoffeees will appear on your billing Involco. I ture Date Driver i- at (e 1 Date Print Name Print Driver Name