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F seRvlc CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA FORM N0. WOE5004- B (4/17) 1 -800- 727-2879 SERVICE ORDER NO, FOR ACCOUNTING CALL: 562-231 - 1550 I � WORLD OIL ENVIRONMENTAL SERVICESTM s 300 CHEVRON WAYr DIXON CA 95620 II PREMIER CHRYSLER DODGE JEEP RAM �F 1 -800427-2879 P 34Q0 NAGLEE ROAD WWW,WORLDOILCORP. COM 3480 NAGLEE ROAD E T TRACY, CA 95804 TRANSPORTER EPA # CAD028277036 TRACY , CA 95304 Q ( 209) 820- 1815 (209 ) 8201815 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES PRE147 ER-86 TODD avelmuez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # 9/ 19/2018 CAL000385003 ( CS'? 9 L� 3 PART # DESCRIPTION QTY UNITPRICE QTYP/U TOTAL BRAKE BRAKE LATHE SHAVINGS PER DRUM 1 $225 . 00 $225 , 00 15 .OIrM 15 GALLON O/T METAL DRUM (NEW ) 1 $54. 00 1 $54 . 00 EMS EMANIFEST EPA FEE & ADMIN SITE SPECIFIC MANIFES1 $ 10 . 00 ) $ 10. 00 BATCH _,_ -- Effective '111120 18, Service order with aesooWed flax waste mtuWasts (itis epeoiQrJewsal ) are subto an EPA Fee. F ewer Pry Pt1ss- CASH RECD: r CHECK # WASTE DISPOSAL INFORMATION NON -RCRA HAZARDOUS WASTE, LIQUID ( USED OIUMIXED OILS) STATE CODE 221 NOWFICRA HAZARDOUS WASTE, LIQUID ( ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: - DESIGNATED TSDF: — — ALTERNATE TSDF: --- a �'tnr�is v v — cmc mt ;� .rra , tt tcirnf — DRUMS P/U : EMPTY DRUMS : FACILITY: BSC GENERATOR WASTE CERTIFICATION ( PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby certify that: ( Waste oilenerator/customer MUST check ONE of the following three boxes) p # 1 ) I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than 1 ,000 ppm, and the waste does not contain any PCBs. I have complied with the requirements of the applicable California used oil management regulations to determine this is true. I agree to accept the additional charges for the disposal of this waste If the information I have provided about this waste is Incorrect i O #21 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 have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. ) agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste is Incorrect - O #3) This waste is from a tank which collects waste oil from household 'do-lt�yourself' (DIY) and/or conditionally exempt small quantity generator (CESQG) sources.To the best of my knowledge, theonly waste oil contained in my DIY/ CESQG collection tank is scley from DIY and/or CESQG sources Uve not mixed this waste oil with any other hazardous waste or waste oil from other sources. ) agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste Is incorrect (All generators/ customers MUST read the following text and check the associated box .) #411f I am a large quantity generalor, I certify Ibat I have a pfogmm In place to reduce the volume and tonnly of waste generated to the degfce l Imvv determined to no economically practicable and that I have cted the practicable method of treatment. storage, or disputal currently avallablC 110 me which rnlnhnhc: or the presort and (Wore Threat to human Ilia dnnm d the envlrnonG sus Or, fl l a 5m.11 quantity generator, ./" 141 hdve made a good faith effort to minimize my waste generation and sdMt 11sc best waste mana9trmeni irw1hod that k av#BBble to me that Icon stud. i Is Individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer, that the forgoing descriptions of waste and materials are true and accurate pa kagrKl, nt f ed and labeled, are ready for transportation In accordance with applicable state and federal regulations, and that Customer shall afa(dr and be bound by the Standard Terms and Conditions on the reverse d eoft F this 5rfv Order /' I Drive n tire' eff us er $I rotor date 9 S ' ` jif Print amiN Print Drivers Name