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. FOR SERVICE CALL: . SERVICE ORDER DIXON QFF/l ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (1/17) 1-800-7-ASBURY 1P10 SERVICE ORDER NO, FOR ACCOONT1NG CALL: WODIY. 562-2314550N2389821 'AF.1.2 .• .: WORLD OIL ENVIRONMENTAL_ SERVICES.. H ST60,KTON C}ODGE INC 7300 CHEVRON WAY,DIXON CA 95620 P =33AUTO CENTER CIRClL'. i 8D4 7 ASEURY PQ BQX 8009 . P WWW.WORLDO.ILCORP.COM E 0 8T00IC1'0N,'CA 95212 : TRANSPORTER EPA#CAO02.827746 STOCKT❑N,CA-9520B T' (209) 477-3888.:: 1209)477-3666 CUSTOMER 1f PURChIA5E 9110211 9 R0.UTE# ' TRUCK# CdNTACT NAME ORDERTAKEN.pY HALIDES DATE FEQUIRED JDATE ENTERED. NEXT 5ERViCE DAT ' ' CUSTOMER EPA#- 01 LT of LAD INda/MANIFEST# $12pi2017 CA0981967660-'. PART# DESCRIPTION QT" "UNITPRICF,;:• ,:QTI�'P/U. TQTAL. =orrM . �ALTLo1v a haw DRUM RECONDITIONED) 2 �az.� $113.36 OILY 5C� OILY Sa[.LUS p R C1RUl1►I 2 $165.00 $330.04 1UTC H# Q0 m 8tree1s: 7C}T.'1L CASH REC'D: CHECK WASTE DISPOSAL INfORMATIOIV' ' NON-RCRA HAZARDOUS WASTE,CIQUID.(USED OIUMIXED OILS);:' STATE CQD.E'221 hDN>RC FIAZAD.O E. QUID,IEE.YLEiVE GLYCOL SOLIfT101Y5) STA77DE QTHER:AS• Cry. � . DESiGNAt,fDT5DF ALTERNATETSOR DRUMS PIU: EMPTY DRUMS- FACILITY: GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) 6ysignirg below I hcrebycertify that: (Waste o i I geheratar/customer MUST check ONE of the following three'boxes) O r 111 have not misyd any of the watts dr;urkedabowt v h any aux;h=rdaus waste,llw soul lsAide ewnent is USS than 1AM pfxrs,unu thrwvsrrdon nN contain any Peas.I hove compiled with the rrtLulu2 Tem s of the applicable Cltlifamlo used oil m;magmnent feg2nraons to deterrntrse thlsls trstr.l agtryY•uaacopt ttw adslftlanal chatoos her Ow diq*wof tlslt w44te if the hrWtnt tlon I hawprovi,led aostt this svaste is 1nr oltect` ma;Ihnrrnotrr crdonyorthaw•astgdasntbodabovewlthanyatherh zarclwaslc,thetotal101docnrslentIsGREATEfllhanl,(Mplim,andthewastedoesnotconlalnanyPCth.1• ' have prm'k1eJ yroprr dtxtnt?entadrsp to Wmld'W f0wronmental Service sto itbwt-Ihr pmiamptlnn ilial this waste was mlKed with other huonlaus waste I a9rce to accept the atlditlon5l chnges for the,disposal of tills 'viasiv If Lha knfCfriwlirxtihatvptavlded about this waste a WOtvact CIa3)This waste is from a tank which eollmtt waste c4lratrrha4wliold.:do4t.yotrrstlIf'MY)andiar conch v9m%lly exempt smaII quantity hencnator(C E500 Soule es to the best of my,Jun owledpe,the only waste all cohwlryed to my OlyyiEiWi coRectin n lank is achy from DR pndlort UVIS sol#irl•Ijmvei apt mltod this waste all well any olher hasatclous vvmlo or waste olI Tram other solaces l agree to a-cepttha addrtlowl thong as for dlspasal or;ills vnsslr 11 thr Irdfnmalksn i Isavr isrrsi about this waua is iitraftect (All generators/customers MUST read the Following text and check the associated box) I If I am a large qu4lnhy11010a101.1 wrl(fy.tlsat I home lsrugsnrn I»Placr ewcduea the Sroluma onitl toekilyof waste gcnarmlcd to the derpoc I havo determined to t.,c aronomknlfy piactrcable amf that I have ylfcc ted the pnac k[ab e+millnd or It6l mens.stn r499,of drspasal currently aralln Wb(a the which mu ui nuM the prvsrnl and future threaf to human Ills ansl the rnvlronnrtvn;Or,IF I arts a small quantity Ta nerator,I have made a geed f lllh effurtIo enlnimue my wash ganrtatlon atld sft E the be ss waste manngem ent rrreihoss!hat isavaltable to me that t can affold. - Tills Inolvitlual slgr4ng In the space sal forth WI ow on behalf of Custimer represents and warrants I h a t he/she has the authority to bind Customer,Iltse n[(pim descriptions of waste and materials are true and accurate at patknrycd marFrd and lahrde< an-ready for transportation In accordance wiltl;applic.ible stale orsd federal regulations,,and that Customer shill rhe and he f nil by the Standard Terms and Conditions on the reverse slt[r of psis Srirvl[oorder. I or Custom igna are Date ri ' �:gnature []ate Print Na e. Print Movers Name '