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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: YN���V ��� N2.93; 37.4 <br /> 562-231-1550 WORLD <br /> ENVIRONMENTAL SERVICES. <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H <br /> I i, i I=r ; t -eta 1-800-727-2879 <br /> P ,ti4 I O,al�i .-. I I= r`r rCiJ! `^ i I i Iii O AN T ONINI EN T Li=:r'i:!S S LLC: - A <br /> P 70.1 D'AiR c-'Y-' I'W`t' WWW.WORLDOILCORP.COM RIS a('-)X$11r68 <br /> E TRANSPORTER EPA#CAD028277036 <br /> T I_/-•,1 IARC)P. 95 a�:i c r, r�,+ <br /> 0 STO..I�` 0N, CA 9c,215 <br /> r 7riLl993-3, 695 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> f;l\T 608 1ti 7)l!TE "12 �� ©o+ JO-!I`i SC. iE!1Ul_=D-i <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> & '1/1`'0'19 CAi_000)3�S53703 ® <br /> PART# rD�ESCRIIPTIOfN I I �y QTY UNIT PRICE QTY P/U TOTAL <br /> V�JOS� USED OiL \��.`Iti1�fICE CHARGEE 1 <br /> wo USED OIL 1 MiIX C) 01[J..; 120 .:2 y0 <br /> j^HiQ'2n. <br /> TOTAL <br /> CASH REC'D:• .T . CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-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: &Sfs, MY ENO afiv r w(w rzr <br /> ra a r&r_1 0.5 CAI 000malya <br /> ALTERNATE TSDF: <br /> rcgrnr t' Marten <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> Of ;`,' f/l { <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIA�!'EY13&f 2 ((f�� ��� <br /> By tgnln,,below l hereby ceriffy that: �I 4 <br /> (Waste oil generator/customer MUST check ONE of the following thre -bGXeS) <br /> #1)l hove not mixed any of the waste described above with any ether hazardous waste.the total hairdo content la LESS than 1,000 pprn,And the waste does not c�non to n ahy�PC I•ila,1 <br /> amplied whit the requirements of 1heapplicable Calffomla used oil management regulations to determine this is true.t agree to accept die additional charges for the disposal of his vTrisim•If <br /> the Information i have provided about Ihts walla fs incorrect <br /> Q #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 <br /> have provided proper documentation to World 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.l agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> 0 #3)This waste Is from a tank which collects waste oil from household"do-it-yourself"(DIY)andJer conditionally exempt small quantity generator(CESOG)sources.Tn the best of my <br /> knowledge,the only waste oil contained In my DIY/CESOG collection tank Is coley from DIY ancVbr GESOG sources.I have not mixed this waste all with any other hazardous waste or waste oil <br /> 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 <br /> (All generators/customers MUST read the following text <br /> I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This Iddlvidual signing in me space set forth befaw on behall of customer represents and warrants that helshe has the authoilly,to bind Customer,that the forgoing deteriptlons of waste <br /> and materials are true and accurate as packngnd,marked,and labeled,are ready fortransporiallon in accordance with applicable state and ruderal regulations,and that customer shall abide <br /> by the Standwd Terms and conditions an the reversa side of ihla Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specifle or consolidated)are subject to an EPA Fee Th lees cover the EPA pass-through fee and administration <br /> of the eklanlfest p ogram. Tile fees vary based on Manifest typo.Appllcabte tees will appear on your billing Invoice. <br /> rl <br /> 1q/ 19 <br /> } Custo Sign re Date Dri Ignature`'j' Date <br /> �1 <br /> Try�el?,e_e <br /> oriM nri., nt_,.r,- <br />