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SERVICE ORDER FOR SERVICE CALL: DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO, WOES004-B 1 -800- 7-ASBURY sal/C1 250 SERVICE ORDER NO. PARLIER 1*0[) IY N [ 3220 't 559-498- 0240 AF 150 CHICO 800- 733-9043 WORLD OIL ENVIRONMENTAL SERVICES +M Sf 'r� E NMHR (:;HRYSI" ER DODGE JET F. r1 RAM (MOO SOUTH SANTA FE, COMPTON CA 90221 P 3x960 ivAGLLE RIJAID LOS ANGELES OFFICE 3460 NAGLEF RGhL7 P 1 -800-9744495 D fftViCY, CA 95304 TRANSPORTER EPA # CAD028277036 TRACY , CA 05304 T ( 0209 ) 810- 1 K1 L"> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES FBF 11 '7 3 �/ STEP )-! �tf •II { Vol � zcl : ) e z. DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # l! 7/2ri1 i' 1AL0003S5003 [ i / ^ �y U � , If 4/ y 7` ; 1 , PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 55-C7/TM 55 GALLON OTT TOP DRUM (RECOINDI (lC) NEG) =U ` 52 , 00 0? :+ 112 3? OILY SO OILY SOLIDS PER DRUM 2 - $ 1315. 0n BATCH x � r05 , :7tretri2r ' TOTAL CASH RECD: CHECK #. WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID ( USED. OIL/MIXED OILS) STATE CODE 221 NON -RCRA HAZARDOUS WASTE, LIQUID ( ETHYLENE GLYCOL SOLUTIONS) STATE CODE __ OTHER: - -- - DESIGNATEDTSDF : _ . - - ALTERNATE TSDF : Li DRUMS P/U :�__ EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION ( PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby certify that: ( Waste oil generator/customer MUST check ONE of the following three boxes) Op 1 ) 1 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 t have provided about this waste is incorrect Out 1 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 I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste Is incorrect � A3) Thls waste is from a tank which collects waste oil from household "do-it-yourself' (DIY) and/or conditionally exempt small quantity generator (CESQW sources. To the best of my knowledge, the only waste oil contained in my DIV/ CESQG collection tank Is soley from DIY and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste oil from other sources I 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 .) �y r •11 If 1 am a large quanuiv ueneratw, I certify that I have a program it, Place to reduce the volume., and tosirlty of waste generated to the despee I have determined W lx cSnnoml<ally piachrable and that I have i ( skh: ted the practicable method of ttextment, narage, rx disposal currently noifnttle to me which minlmlzrs the present and future threat to human llfrr and the erwlrooment: Or, If 1 qru a small quantity generator, l I haws made a good faith effort to Infnlmlze my wxto gericretlon and eelectthe best waste marlartenWnt method that Ic available to nce than t "n afford has a authority to bind Customer, that the for oln descriptions of waste and materials are true and accurate I ' tl+n Ihdwldu I nl the space set tnrth tselow on udwlf of Customer mprewnts and warrants that he/she h y 9 9 P �1 1g 1 JtpKka�ft�. t d arld labt k^d, ale tesdy for lrannpoUatlan In xcurdance.w{lh appllcablr state and federal regulations, and that Customer shah abide and be bound by the Standard Terms and Conditions on the reverse 9 Ode of t)tfs Set Wei. ' f "I Custof'O gnatu±e Date Driver Signature Date I ; /. � Print Nar a Print Drivers Name )