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ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES002-B (5/18) FOR SERVICE CALL: DIXON SERVICE ORDER 1-800-727-2879 FOR ACCOUNTING CALL: N NO. 9 08 0 562-231-1550 WORLD OIL ® 'Y C3 7300 CHEVRON WAY DIXON,CALIFORNIA 95620 (800)727-2879 EPA#CAD028277036 Date /a - f/ l Cl Customer# 0c,-T Customer Aad':�n r(A o'1 :e Ai EPA# (' 1,C% Address '�r^ A r-(�Y r-� (.0�I Commodity City State 'a Zip ��3 Halides PPM Phon(7 , C G'? - , fjContact Amount Cash ❑ Check# Notes: Waste Disposal Information V❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE_L!J ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)STATE CODE 135 ❑ OTHER MANIFEST# %�")) 1C)Cj n Fes';r NEXT SVC DATE DRUM SIZE QUANTITY TRUCK NUMBER Z- ) - DESIGNATED TSDF: ❑ - WORLD OIL RECYCLING*2000 N.ALAMEDA STREET*COMPTON,CA 90222*CAT080013352*(310)537-7100 ❑ WORLD OIL ENVIROMENTAL SERVICES*2549 SCOTT AVENUE*CHICO,CA 95928*CAL000827844*(800)733-9043 - ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO II,LLC*1618 W.5TH STREET*CHICO,CA 95928*CAD980694103*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA*200 DINSMORE DRIVE*FORTUNA,CA 95540*CAL930256136*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES*7300 CHEVRON WAY*DIXON,CA 95620'CAT080012602*(707)693-6008 ❑ YUMA YES LLC*2730 E.13TH STREET,YUMA,AZ 85365*AZR000515924*(928)643-8938 ❑ RAMOS ENVIROMENTAL*1515 S.RIVER ROAD*W.SACRAMENTO,CA 95691 *CAD044003556*(916)371-5747 WORLD OIL ENVIROMENTAL SERVICES*1920 MORGAN RD,STE AES*CERES,CA 95358*CAL000393680*(209)541-1825 ❑ BAKERSFIELD TRANSFER INC.*1620 BRUNDAGE LANE*BAKERSFIELD,CA 93307*CAL000282598*(661)377-0308 ❑ WORLD OIL-SAN JOAQUIN, LLC*14287 E.MANNING AVE*PARLIER,CA 93648*CAL000102751 *(559)498-0240 GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) (❑q1)1 have not mixed any of the waste described on the service order noted 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 It the information I have provided about thls waste Is incorrect. (❑112)1 have not mixed any of the waste described an the service order noted above with any other hazardous waste,the total halide content is GREATER than 1,DD0 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. (❑e3)This waste Is from a ark which collects waste oil from household"do-it-yourself-(DIY)and/or conditionally exempt small quantity generator(CESDG)sources.To the best of my knowledge•the only waste oil contained in my DIV/CESDG collection tank is solely from DIY/CESDG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additicnai charges for disposal of this waste it the information I have provided about this waste is incorrect. (All generators/customers MUST read the following text) I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined 10 be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future fhreffi to human life and the environment. This individual signing In the space set forth below on behalf of Customerrepresents and warrants that he/she has the authority to bind Customer,that the forgoing description of waste and materials are true and accurate as packaged,marked and Labeled.are ready for transportation In accordance with applicable state and federal regulatEons and that Customer shall abide and be bound by the Standard Terns and Conditions on the reverse side of this Service Order. i I 1 ,i G1 , 11 C Cast er Signature_. Dat _.Dri Ignature Date Print llie' / Print Drivers Name