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SERVICE ORDER FQR SERVICE CALL: DIXON OFFICE �kSBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (4/17) 1-BQQ-7271284 91(1f0(350 SERVICE ORDER NO. FOR ACCOUNTING CALL. WODIY 0; t 562-231-1550_ N25271 W AF 175 WORLD OIL ENVIRONMENTAL S.ERVICES1. HOCI{T4N DODGE tNC 7300 CHEVRON,WAY,DIXON CA 95620 I 1-80Q-727-2879 3333-kt0 GEt4TEA CIRCLE PO'BOX 8009 p WWW.WO'RLnILCORP.COM - f STOCKTON,CA 95212 TRANSPORTER EPA#CAD0282.77036. STOCK.TON,CA 95208 T . (209)477-3868 (209) 477;3888 :CUSTOMER# PURCHASE ORDER# ROUTE# •TRUCK# CONTACT NAME` ORDER TAKEN BY HALIDES. STOE127 R )UTE.124 p SCHEDULED-ll DATE REQUIRED DATE ENTERED NEXTSERVICE PATE CUSTOv M EPA# SILL of LAvINGMANIFEST I M&201 8 2/22/2018 CAD98.1907MriZ33 LY I. v-, PART!! DESCRIPTION QTY UNIT PRICE QTY P/U TdTAL VVOSC USED OIL SERVICE CHARGE A $80.001 4q 57 $80:00 .' USED OIL/MIXED $0.00WO BATCH I 9 Cm St»6"e3: Get slnat>Jre front Cagy, J TOTAL- CASIJ RECD:• CHECK III Arnlarsaga�Ufa�t ' WASTE DISPOSAL 4NFORWATION '•.NON-RCRA HAZARDOUS WASTE,LIQUID(USED QILIMIXED bILS) STATE CODE 12.1. NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS). -STATE CODE OTHER: DESIGNATEDT5D0:--AS3.tlWy-F.WRONMEITrAL S RVICMCEr;ES,t9M-M0RW"f]; ERF_rQ"63W Q)54"- ALTERNATE TSDF: DRUMS P/U: EMPTY QRUMS: FACILITY: - BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) By signing below l he rrby a rlily that (Waste oil generator/customer MUST check ONE of the following three-boxes) %CiPffo I)I lioec not INit!d my o the wa-,It-le•tulle-d nhwr m[h any of hot Iptiiatiiuwt"3314 the total Ila Ije conwht is LINS iltan 1,06O plsm,aid the vesues[oey nor contwet any KU I have tomplled wink the reqIII reminII of thcappllcableCalifmntsusedo11.tiamigemrntrtgulatianstodelrrminothhlstrue-lagrlrtobcmttlwalditiorulcfimgrIfor ihefttssalat11+11waurdThe lnromsa=tool?In%*provided abuuIIhis wastrlaricortr$- A EQa?I have on t mi,M arty of lltewinte do u.,,bed attune wii Is any other ha rmdain vmalr the laid halide coate]t IIs GA@ATEA I has 1.60P ppm,ttnd she wkste dor s not coMOfrl Any PC93.l hs d giuvulrtl p+oprr drm>fhahsktirlaet m Warld N f y:ion nentul"y1ces to rrbul the IyouRtpIion that this wasteswf.mlzigd phiiolher ha.ardouswa.iI I npree to accept theaddlilonal charges for the disposal of ihls. Ae if rhe int..,.,heve1.lsnvio aboutih,"W Is lhcorrect• - 0710 %wrnty is front atank which eullectiwaste nil koro h-0gadrotd'du•I},yourself'(a1Y)andyoteci�llnhally c.emptlrrW quantity gentrwor(CESOG)tourers.To the best of my knerriedge,the only wame 611 emmined in my tMa5&B d4ocuun t ank is soler ftam W nr+d/al CUtjG sources,}have not miard thls waste 611svith any othhl hazardous wastwor anile oil from ocher touices.I agree to adept the addllional charger for dh*osal 'of Iltfi sviste i1 the Iniomullon I ha1•r prcv]drrl alnul rlHs waste ti loco=reef (All generators/customers MUST read the fallowing text and check the associated box.) &I If I errs a large civan Ili r grgemtgr,Inv illy that I have a program In place to reduce the ealrame and toxic]ty of waste generated to the deoree I have dei ermined to heucenumkalty pea eirea We and that I have seirtted sha prat ticahla r srihv J of tmalmrnt y,rx7gr,ar disposal csrmerdly avafla0lr Iomrwrdch nlnlntizes the prescns and future threat to human lire and the environlrteni;Or,If 1 am a smallgdanilly generator,I have made n grrnd ladh eHim to minrmi:e mywalte generatfan and sotrtttbe 7 tn%wase rnarragemcni FnWhad that is available to mr that I can alfotd. This individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bhtd C113'tUMCr i the flornq descriptions of waste and materials are true and accurate pacot d.mar 11:4 MCI labeled,at dyrw tr.mepor tai lon In accordance wi I h applicable state and federal rrgulapans,and that CvutunrnK IAbidu it be bound by the Standard Terms a nd Conditions on the reverse w of Phis rvire 4rrlcr. •r , ature�� Date er ignaulre Date Print Name Print Drivers Name