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FQ . 1E VICE CALL: SERVICE ORDER *bR)AI OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-0 (4/17) 1-800-727 879 WO 6550 SERVICE ORDER NO. FOR ACCOUNTING CALL: 562-231-1550 WODIY O N2� 1 r AF 125 WORLD COIL ENVIRONMENTAL SERVICES,. H STOC:KTON DODGE INC 7300 CHEVRON:WAY,DIXON CA 95620. P 3=AUTO CENTER CIRCLE 1-800-727-2879 PO WX 8WID P WWW.WORL'DOILCORRCOM E 4 STOCKTON,-CA 95,212, TRANSPORTER EPA#CAD028277036 STOCKrON,'CA 95208 o (209) 477-3a68i (209)477-3668 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK, CONTACT NAME' ORDER TAKEN BY, HALIDES` NT ON,ER-8$ IOHN STAON avela�tquez DATE REQUIRED DATE ENTERED NIXT 5ERViCE DATE tUS7OMER EPA4 BILL of LADINWMANIFEST ii j 2/161201,a c, os a1 ss�sso PART# DESCRIPTION QTY UNIT.PRICE ' 'QTYP/U' TOTAL' MIXED MIXED.-I UELa PER DRUM 1 $225;00 $226.00 55-CfTm $600 r $50.88; 3VA , BATCH 0 �r Cro Str6B�tS� 90 sigpeture fhom .COSY. r..., TOTAL CASH R!Z'U:" cHEcK,i►-- G#t*. ' WA'STE.DISOoSAL INFC]WNnON• NON-RCRA HAZAROOUS WASTE,LIQUID(USED OIUMIXFD OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE;LIQUID(ETHYLENE'GLYCOL SOLUTIONS) STATE COOS. OTHER - — -- -- 'DESIGNATEDTSDF: — -- - .. ALTERNATE TSDF: { DRUMS P/U EMPTY DRUMS: I ACIt I rY: GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing beluw I hereby ter lily that: (Waste ail generatorkustomer MUST check ONE of the following three,boxes) E el)I have not mired any or the waste d6cribad ahwrwith anyuthLa)wardous xassr,the jowl harhie conjem Is LE5i than I,00q ppm,and the waste deet S7pt contain any PCSJ;f hwecomphed With the requlrgircr is of t1p applicable(,1W(nrnia used,oR mal+agaaien!mgliglailoar foMIrtmine this It uu�Iagrce. thh additloru1 eba++jes fpr•lhc da4wia]of this was la olse Informoon I'hw>prWr kd about this wast a is I nca rreit C=021 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I hast provided proper docs t"niWon m World Oil ErwircrtMeglal Services to rebut the presumption that'this waste,was mixed with other hazardous waste.l agreB 1p accept.the additional charges for the disposal of this -Wasl¢If lheh4ormdlion l have Ploy?id PI§out this wastels oeorttl' - O ra)T1ds waste is Irorn a lank which collects waste off from h'ouschold'do•n•yo+uself'(DIY)and/or condltlo rally exgmplsmall quanthy generator(CESM sources.To the best of my knowledge;the only waste oil contained In my 1)WCES DGcallectron tank IS soley from DIY and/or CESQG sources.I have not ml.ed this waste alfw•ith any d i h or ha ra rd ous waste arwaslc ail from otbetsowces.I agree to accept the YJdition al charges for dlspoSal of tills waste If the Information I have provided about this waste is Incorrect , "Illy customers MUST read the Following text and enacts tf�e associated hvx.) cal Il I am a torr quansitygrncculor,f ccrulyshat I hour a prwusrn rnp]atr to rrdu[r lhr vokuma and is7xscityaf wash genwated to Ina degrer I lsavesfetersnfnod[else ttpnondciRy practtcahle anal that t huvr e7led the pratgSahle met OF ll tleragr o7 drlfxx'I curr I"y avarlalfl1 to rot whklt rd}rtlm1Y¢t Ihy prasent apd fulurr Ihreat[o human IIfC ane lr+e prnironnreM;4+,f1i am a trntll i)uaniRy rjellerataf,i va rtsadc r go[�iaith aHnrt fA rnfnlmlre asp warto+jprxratlon and xllcl lhr besbwmur rn7hagt:Rgnl irri•Ihuf that fl•nvakL+tllelo mn llws Scan afford- Tt11t rllvsdua ifgr+{ng In lila 1patC tel fvrsfl belrm un bt�salf of�tnt(rfrter lyy?reienlS Jed wafranLitlWth•Chi'rr hallFM ntlthdrlty to hlfnlfufl0mnf,IS4N151 re rtxtitlhlJ drHriplksn+of wasta And nsrterral)rrc hull ilyd aC[ufalc as packagal•nnu k.Yl 5nd Inbrled,arc ready for transportation In accordance vnlh applicable state and Icdeml regulat ons,and that Customer shell abldr and be lwund by the Standard Terms and Conditions an lila rcvege srdr of U r,M ceGrdcr- Cost rrer gnature Date Driver Sits Date %_.. 6-1 �� Print,Name Print Drivers ante