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r I <br /> FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2878 <br /> -a310`1;-1307 <br /> FOR ACCOUNTING GALL: <br /> WORLD OIL <br /> 562-231 1550 <br /> vtl <br /> ENVIRONMENTAL SERVICES;, <br /> g <br /> 7`100 CHEVRON WAY,DIXON,CA 95620 <br /> H ADVANCED J 1�C?� l`!ti'1 <br /> 1 Cry lC.i _C CSIi 1-800.727-2879 <br /> E <br /> pR1/ ! WWW.WORLDOILCORRCOM 3837ILPER,fL.WAY <br /> P3837IMPE _ JAY <br /> E TRANSPORTED EPA#CAD028277E13S <br /> 1) ,+ �t tj,, 952,15 <br /> ��} J rVr rOF, r'2 6 <br /> :�`�✓f✓I'�t.I�L�1L, �✓A J52 I 5 Y, ��4 ,�i.�1 cf.til <br /> i <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN 13Y HALIDES j <br /> a, s/ <br /> `32 5 )tP E '4 iCi1; 1C,:1(.�A(3Af� =/i!� rFtta IPiari — <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# RILL of LADING/MANIFEST# <br /> 99f27120 10 _000,38131 2 <br /> jig 1f5 :5o3Z1JJ <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> V/O?tiC'. t 1,ccE_-C) Cell.. 3 E R V!C, C'! I?URGE I Cis.tJl':3 <br /> "No t.m)ED Oil.,/ISI IXE-L) Oil—S 100 00 �� $0.00 <br /> i <br /> i <br /> I <br /> i <br /> !3ATC.H ti <br /> TOTAL <br /> CASH RECD: CHECK#. .. .- <br /> WASTE DISPOSAL INFORMATION <br /> NDN-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE ---- <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF._ <br /> I: <br /> DRUMS P/U:__..- EMPTY DRUMS:_ FACILITY: - . SSC - -_—_ <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Write Oil gprrerator/customer MUST check ONE at the following throe boxes) <br /> 1 have not mixed any of the}vacfn elesrllbn€€ehcYi whit��ny ashar Et:azarsfour.vrm:aW €lie tutai€ii1110t;(;ontunt is ILfwSa than 1.000 ppnL Buri ii€c vraoe does not ront.yin any PCBs.f have <br /> ,_'oittpiled with the requiremonis ar lho applicithla caijieitib ua-!+kill riraiwi7emv-nl ri<q%Illi €o d:riat;€shte ttii3 I�arms.17c ire to uct5pl the addillup al elineges lot liie+flspcsal of this waste If <br /> the informaflon I have provided about this waste is Incorrect <br /> #21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,001)ppm,and the waste does not contain any PCBs.I <br /> have provided prop^_t documentation to World Oil Environmental Sta*;as to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> chafges f.r jhe t)fsliuual of this waste if the information I have ptavinnti about this waste€s Incorrect <br /> Q 03)This waste is from a tank which collects waste oil from household"do-it-yourself"(1)IY)and/or conditionally exempt small quantity generator(CESOU)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CES00 collection tank Is soley from MY andfor CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from outer sources.I agree to accept the additional charges for disposal of thk;waste if the information I have provided about this waste is incorrect <br /> (All generators/custorners MUST read the following text <br /> I certify that I have a program irk place to redone the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have salaried the <br /> practicable method or treatment,storage,or disposal currently nvaliable to me which minimizes the present and future threat to human Ilia and the environment. <br /> Tiny iniivid,tni zirpntig to 0w spare set tnrtli taflinw.m hnh,tli e.!ruratn,a+rr tnjimes:Pnts and warrants that hn,hn teas the authority to bintf vurlomer,that rho forgoing deserlptions Of waste <br /> and malerials are hug:and accurate an pnckas3ad;marl d;and Iabeles),ago 16.0y for transportation in naco(daore with applicable state Find tednral regulations,and that customer shall abide <br /> by lht Slamli it Taini.a and Conditions on the rtiv(,7f.?rids of Ihf=i Scriltc-v Order: <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Po, _ .:s cover the EPA pass-through tee and administration '.. <br /> of the ehlanilest program.Theca fees vary based on manifest type.Applicable tees will appear on your billing Invoice. <br /> r AD <br /> CE 0)ler Si fie�tUre' Diir� � Driver�IC�I <br /> lBtliri: Date <br /> i <br /> Phi "Artie Print Driver Natne <br />