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FOR SERVICE CALL: SERVICE ORDER
<br /> DIXONOFF! ASBURY, ENVIRONMENTAL.SERVICES, DBA FORM NO.WOES-G04-13 (1117) .
<br /> 1-900-7-t15� RY V�fU 650., a
<br /> SERVICE OR NO::
<br /> FOR ACCt�[,t1 TINO CALL:WOL71Y Q' P12340i 74
<br /> 562-231 `f'55D
<br /> AF-125'
<br /> WORLD O I L
<br /> EN,VIR;CJNMENTAL SERVICES
<br /> H S I C]GKTQid ❑CSC]{3�INC 7300,CHEVRON WAY,.OIXON CA 95620
<br /> P 33 AUTU C! NT€ R''CIRCLE 1 8t10-7rA5BURY pd•BOX•$009
<br /> p WWW.WORLDOILCORP.COM
<br /> ST. "TOCKTON,CA 95212 TRANSPORTER EPA tl CAD028277.036 STi;JC1CTQN, CA95208
<br /> o (209)477'•388$,. .. (209) 477-366$
<br /> CUSTOMER N PURCHASE ORDER#' ' ' RO.U.TE II ,TRUCK)) CONTACT NAME ORDER TAKEN BY, HALIDES!
<br /> S'T057.7 �� 124
<br /> DATE REQUIRED DATE 601-RED NEXT SERVICE DATE CUSTOMER EPA 1k HILL of i-AUING=NIFEST If
<br /> =3120'17- 3/2312017 CA09819676801 TJ :
<br /> PART!! DESCRIPTIC.N QTY UNIT PRICE QTY PIU-, TOTAL .
<br /> WOSC USED OIL SERVIC&CHARGE. 1 $SO.OQ $80,00 .
<br /> W,b FUSrEDOLIMIXED OIf_S � t7.Q4 $0,00.,
<br /> BATCH
<br /> Cros 'St qty:.
<br /> TOTAL
<br /> L
<br /> CASE t
<br /> ��l w• r {x._u ' :•i :.,,i ,' WASTE DISPOSAL-lNFORMAfION .-. .... ._......,,..__
<br /> }L/,fU)IJiCi7C1ILS) . 5'1ATE:CO0E2.21
<br /> NOAIrRCRA'}fA7�iRt 1fI 'GLYCe7l:_SQL.UflONS}. 5'IATF.'COE)E '
<br /> r- - - — -- .
<br /> DESIGNATED,T5C1Fi�= t8B fir i L 4TA�E3 fZ31iEs C 72CFr.$B. Y#�i{tiRC34P3'!�} 011 5,CA ff3�Fn�1 :-4L'�.5 Cf4kL'r7Ei36�{af3:
<br /> ALTERNATE-FSOF:
<br /> . ..
<br /> DRUMS PCU: EMPTY DRLIMSi FACi&Y.'' BSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX)
<br /> fly;Igninq bcluWlhcreby ccl ufy lhac � -
<br /> (Waste.oil,generatorlcustorrier MUST check ONE of the.fgllowing three bo-es)-
<br /> a rJ l have not rnlc+d my of the w]m dpsetlbedabwe.widt anyolhor lsaz nrldut7waslt,chu 101.11 h.ibde content is LESS ilmn 1.*WZS&ms,end the wp:td doesnuc-c unmin any l'Cn s,thav'i cumpacd lAth the tegwrcl cele s ut
<br /> a p plicable Culumia used oil manSgelnent rejul6wGns{0,dk4b?ad;tth .is tr6e.•1a,v,,e[oxer:pu11e,111(1-.1i chp9ns fur fhaol%*.•;I of:1111wim-lf.tha Inf;nna tion I ha,e ptoYldvd a bout this waste IS Incorrect
<br /> =/7l have nut nuked any of the wa;7G dmalL•ed'ahove with any ot"I hauanlous waste•the,taml'haid!content i.GREA1 Ell:ltim 1,0W ANn,'Intl the s•:aII do.s'Int'cunlaiil:Iw.PCBs.l
<br /> 1;ave pl uvichul•wager r1oamerlia tion to World Od ErlvlrCunhental San,Icrls to rebut the pr esu nipl Ion that Ihis waste sues nirw wills lgkf Ira Llyduht wale. tI to:l:cepi Il;a a�idilion:,l charges for the;hspowlof this
<br /> w,1:rdif Ilse ihfntW1160 t lkivn prWkind iWL4 tlrii wastl-11 inenfj&r ..
<br /> =1x3111ilywaSte is,frgd1alank whIds�pllnutwaslgPAhomheus-lIW44.'flu;li•yfAirwIl'(017larvilorcvndllluh:dlyear.rppisrnallgImill tygcn-aatgr(CIS OGlsourres-"fnthabc•slnfinyknoededrptth 6nlyw.l.IpcslleontalnerL'
<br /> .Ih rrlp DiYI CESf7G cnlfrCliOM1i k}YSuICy f7ofn L1{Y hddIAT,CrSt?G ypylr�N;hart not mixed this 4rasU!uil withanyrithel hiyatdoyi waste r,r s:•a••I n ;Jfromo;hersnurcv!lanree lo•xcrpt thL-addnlnnnl charges lot disposal
<br /> of 11117 wn{ia rf this inlgirtlanpp•l ftdue firpridcd atinut tFsli+rastq Iv inct7riic: . --
<br /> (All garleratorsl customers MUST read the foilowing text anti-check the associated box.)
<br /> aJ.0amnInrgegdAnlity:gtrnermot,Icetiffy,IhatlhlWaArugramlmpiacntoredurelhisuptumeandioxithyof:vastygeneratedtofhcd[rwlh7vuch•termlm•Jlaslxceon iw.1llylaX[k.1hlcand thatihave
<br /> -
<br /> tlt: IhA pmcllc vtalp rgnlhod.i lrcnimcrl>;umags:w disposal furrrnmy avanahfc ly me whkh min mir,•s the-prettnt and feu rira lfucal to human IJIe end thy rm•ilnmmem;qr,tf i @m a small quantity gcn.mlor,l
<br /> •Raven Ile a good fault I:Ifcrt to minlndir.mywassr;grnrr,,;ltin'71rd sr-lm Lite br:sl+vastr tisai>;lgC&Wl rnethorlthls 16 aAilablp lu me illi[I t 44ffrutl,
<br /> fhls WWIyl J{tai.+Igoing In ihL•ep.16'set 1.11116ely-:On elr.I colwrnet q•p?e5 ort IS a rid wallant{that hnrlhn hay thea of hnr ily to h in d Cuslni ner,;hat the 181 grinq dMcripUon,of'::a;to apd rnotedals are v uc and acc urate
<br /> asp.%ka[pd;Inarllpdamd lahaFesl,a rcaJyfnr ariTpert.rtiwl.,6crnnlar,ce n Sh ippfliable;tale and feJcrsl meJulall',—.and that b;•blend by the ilantLVd Tarns and Con;lilmm nn the l evcv;e
<br /> :ide.fitt ❑Kr '.t. '
<br /> Customer"Si re Dane Driv rslgnr re D e
<br /> Print Name Pcirlt prfverName
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