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I`Ofi SERVICE CALL: SERVICE ORDER FORM NO.WOES004-8(8118) DIXON OFFI6I_ t ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879. SERVICE ORDER NO. N2737407 F69'ACQOUNTING CALL; WORLD-OIL-l' . 562-231- 1550 1 r� . ENVIRONMENTAL SERVI'CES,u H STOCKTON DODGE INC 7300 CHEVRON WAY,DIXON,CA 9,5620 1-600-727-2$79 P 3333 AUTO CENTER CIRCLE PO.BOX 8009 P WWW.VV,O.RLDOILCORP.COM D STOCKTON,CA 95212 TRANSPORTER EPA#CAD028277036 STOCKTON' OA 95208 T 000)X17.7-3&38 (209)477-36768 CU5 ER# PURCHASE ORDER# RqUTE# j TRUCK# CO TACT'NAME ORDER TAKEN BY HALIDES (DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINGZMANIFEST Y Z-7 po P # CST• UNIjjftE OTY P/U MIXED MIXED FUELS.PER IDRUM 1 $225.00 5 -CITh I 55©ILI.OhI CDT METAL..DRUht1. 2,. ' X2,00: - N EDS E A 9s0-1920 BATCH Ili TOTAL CASH 6EC'D:'' CHECK,# WASTE 015PO5tAL INIrOF MATION NON-.RCRArHAZARDOU5 WASTE,LIQUID(US.EP.01L/MIX.ED.QILs), ..`. STATE CODE 221, NDN-RCRA HAZARDOUS WASTE;LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE C013E_____ OTHER: DESIGNATED TSDF: - — r- A � 5 9P►t3R 0 sign8 a3 m S li�+�r{, i rSfid J Li DRUMS P/U: EMPTY DRUMS: FACILITY: BSC. GENERATOR WASTE CERTIFICATION (PLEASE CHEbK THE APPROPRIATE BOX) By sign any below I hereby,certify that: ° (Waste oil generator/customer MUST check.ONE of the following three boxes) 0 all)I hovo nal mixed any of the wase described above with any other h=11i'Llarl9 Wasie,the lolol hntld*caLritenl is LESS than 1,000 ppm,rind the w3,14—if res not contain any f'CUS.I'Itove compiled with the requirementsol the applk bio Catifomin used oil managotnont regulations to dotermina thin to Ir'up.I ni)ree to accept the nddltlonal dorpcs for,the disposal o+Ilils waste If the Informatlan I hitya provided about this waste Is inearrac! .. 0 4121 have not mixed any of the waste described above with any other hazardous waste,the Intel halide content Is GREATER than 1,000 ppm,and rhe waste does not contain any PCBs.I have provided propor documonlollon to World Oil Environmental Servlcon to ruhul the presumption that this waste was mixed with other hazardous.waslo.I agree to accept the additional charges far the diapasnl of this waste II the Information I have provided about thls waste Is Incorrect [� 419)Thfawasm Is h6rn a lenkwhich collects waale all from Itouarhold"do-it-yoursell-IDIY)andlarraniflllonally exempt small quantity,gonoralar{CESOG)suurces.1-a iho.best of my kriowfadt e,Ilia only wa%te all codiatnad In my DIYI CESOG salWicin tank la aaloy,from DIY andlor 1;ES4013 nourcos.I have not mlxod INIs waoto alt WA any ornar hazardnus waste or 14aste oil from olliar aourcen,I egrae to accept the addlttone$chary vb'fer 4Irposai of this wade h the inlormallbi)1 have provided about Ihly waato Is incorrect (All generators/customers MUST read the following text I crrlity IhaI I have a program In place to reduce the volume and toxlclIV of weclo gonemled to aha dog roe I have dalsrmined to be"onomicolly pra0cobi a and Ihrit 1 hnva selected Iho practicable method of Ireatinent,storage,or disposal currently available to.me which mtalmizas the present and future threat to human life and Ihernvironmeni. Thla individual stoning In she space set forth below on behalf of eustomor ruplosents and Warrants that horshe ties the authority to bind customer,that the Iorpolng descriptions of waste and mnlertaln ara Trus and accurate as packaged,marked,and Iaboled,are ready for"nspotlallon In accordance with applicable state end faderol regulollona,and Ihmt eustomor,hall starts by Iho Swri1nrd Term&and Conditions on the reverse side of this Service ardor. Service Orders with an acsoelalad hazardoop wade maniluut(either spaclllc or consolidated)are suhlocl to an EPA Foo, t cover ilia EPA pass-through leo and odminlclnllon of the amanyosrPI-Agram.ThMokaes vary lanced on Monlleal typo.Applicable foes will appear on your billing Invoice. zg' f Cu3id61er Signature. Date r Signa� Date. Print Name Print Driver Name