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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: C),)WORLDOIL <br /> 9562-231-1550 <br /> ENVIRONMENTAL SERVICESn, <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> I ANTO 111v ENT ERP" `IS i i '[H P 1-800-727-2 7 r rn! t to714 <br /> I ��, I S_ _l.G • _.�t 14�" 6 9 ;�N-(�!f'��:�i �C�1TL-t��I,.�..ES LL.C. H <br /> P 701 G'APC`(ISI-<1IVY WWW.WORLDOILCORRCOM F)O SOX 8468 <br /> E TRANSPORTER EPA#CAD028277036 <br /> .ATI-IrOP,CA 95330 S-1 OC'KTCN, CA 9521 <br /> 05 <br /> (2G4)) 993-8395 (209) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT 608 ROUT E JOHN 8OI IEDUI_EDJ <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 53iu,'Ci120 i 9 9/'i 012019 CAL.000383703 �-�,•� q •"T jI <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> VVO;,C USED Oil_ SE ViGE CHARGE <br /> E:i�I. I �® <br /> WC) USED OIL.1 IvilXED OILS 24.0 <br /> �C iiJ?uc..lGu-;�00 BAT(.'If r <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: _ <br /> DESIGNATED TSDF: 45*I)R-r SllrlRt'iNLl oPNTAa E ��nc .,, £f135, �L�n r,��I�S il�1�(zw .SJ�u _( n2_a� :r f_�a25,CAI R003CI-V <br /> _ ALTERNATE TSDF: <br /> Arf'(vint Mara ¢r:_ rzuic <br /> DRUMS PN: EMPTY DRUMS: FACILITY: BSC <br /> lili I�r'I <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATI 2��9 <br /> By signing below I hereby certify that: r <br /> (Waste oil generator/customer MUST check ONE of the following thr �oxes) <br /> rl f)I have not m)xed any of tll waste described above with any other ftazordous wash,the total haSde content Is LESS Shan 4,000 ppm,and the waate�ods-smt c`o.rj-t_a4n'any•PCBs,.}kava <br /> compiled with the requirements of the applicnble California used oil management rcgulallons to determine lhla is true.i agree to accept 1he additional charges for the dispos'til�f ihls waste <br /> the information i have provided about tills waste Is incorrect <br /> Q #21 have not mixed any of the waste descrl bed above with any other hazardous waste,the total halide content Is GREATER than IkOOO ppm,and the waste does not contnln any PCBs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with ether hazardous waste.I agree to accept the addtilonal <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect. <br /> Q #3)This waste Is from a tank which collects waste all from household"do-It-yourself'(DIV)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESOG collection tank Is soley from DIY andfor CESUG sources.I have not mixed this waste oil 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 in&%oldual slQning In the spnee set forth below on behalf of customer represents and warrants that ha%h6 has the authority to bind cuslomer,that the forgoing descriptions of waste <br /> and materials ale?nle and ercurate as packaged,marked,and labelod,are ready for transportailon In accordance with applicable state and federal regulations,and Iha(customer shall abide <br /> by the StandardTorma and Conditions on the reverse side of this Service Order. <br /> Servir a Orders with an a ! ted hazardoua waste manifni(either slte spcclfic or consollduted)are subject to an EZDHILgnatura <br /> r the EPA pass-through fee and administration <br /> of the a Jlnttest progra i e Fees vary hared on Manliest type. Applicable fees wl11 appear on your billing Invoic <br /> 1 ,11 , t9 <br /> Customer Sign fur Date Date <br /> n«...a nr....... � orin+nri•rn.•Almm� <br />