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'FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550L�,'VOFZLDOIL <br /> ENVIRONMENTAL SERVICESTM <br /> s <br /> H 7300 CHEVRON WAY, DIXON,CA 95620 <br /> t 1-800-727-2879 -. <br /> Ri�TGh!Ih�I EP!TE Pt�ISt=S LLQ- LI;T Ir.OF l.�NTONIN) ENTEF.!PRI-SES [-LG-A <br /> P 701 D'ARCY Pn,,AP( WWW.WORLDOILCORP.COM PO r-OX 3438 <br /> D TRANSPORTER EPA#CAD028277036 <br /> T LATHROP, CA 95330 <br /> O S..i�7�W:I{�I�l, CA �:5.� <br /> 1 <br /> ,'2()9) g93-3695 (20:x) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT608 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> I J/111?0 119 CAtL000081700 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF USED im-TAL 01L AND GASOUNr. FIL ERS �. <br /> OFDR 0 1 L IL T ER DRU1.1Vi IFh�:PLACEMb I\I T- NO C[_;I IRG3E 4 <br /> K'I'N 0�' 4l6-4,Gr.' BATCH-,'r, <br /> TOTAL <br /> CASH REC'D: 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 /> _ �.��_--��,' � " '-�.-��'� LOE��.ti.- - <br /> DESIGNATEI]'fSDF: -- :nils •l r,� r r,—1 GL:_Vl 1A V aF Nq TNfA. A7 nrl*.Apr;. <br /> ALTERNATE TSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIAT BOX) <br /> By signing below I hereby certify that: 8Yt <br /> (Waste oil generator/customer MUST check ONE of the following three es <br /> #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.l have <br /> 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 <br /> the Information I have provided about this waste Is incorrect <br /> 0 021 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.l <br /> have provided proper documentation to World 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I 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 03)This waste Is from a tank which collects waste oil from household"do-it-yourself"(DIY)andlor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste all contained In my DIY/CESOG collection tank Is soley from DIY and/or CESOG sources.I hove not mixed this waste tilt with any other haZardGZPs 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 1 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 individual signing In the space set forth below on behalf of customet represents and warrants that livlshe has the authority fo bind t: 14lomer,that the forgoing deseriptlons of waste <br /> and fruit ais are true and accurate as packaged,nsarked,and inbeiad,are ready foriransporlallon In accordance with nppticablo slate federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of This Servico Drder. <br /> Service Orders wll r associated hazardous waste manifosl(either site specific or consoiidaled)are subject to an EPA Fee.These c ver the EPA pass-through fee and administration <br /> of tt eManif rogram.These faes vary based on Manliest type. Applicable fees will appear on your billing Invoice. <br /> U mer Signature Date Driver SIgntui Date <br /> D­+nelvor lkl.mn <br />