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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: N3264532_ <br /> ;'WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES,. <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H AN'I ONINI EN-i�RPRiSES LLC- LATFHIIRO AN T ONINI ENTEF.;PRiSE� LL.C.-;tiN T <br /> 3.800-727-2879 <br /> P 70'1 D'AFRCY Y!,�11y FSO EOE€8168 <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> II,i NROr, CA 93;3 TRANSPORTER EPA#CAD028277036 <br /> T 8TGGK f CN, G/1 9/52'1 <br /> o (2.09)j qua-36-95 (209) 41661-4900 <br /> CUSTOMER#• PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> FAN T 508 1 i0ij i E -1:2',L JOHN <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 6/3/'2020 CAL'000385703 45-2 Z 16 0'` R: <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> vyUZ3G USED OIL SERVICE CHARGE 1 <br /> WO USED OIL/ MIXED OILS 250 0-70 <br /> JOHN 2C 3-466-4900 'BATCH 1x <br /> TOTAL <br /> CASH RECD: 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:AS91JR.Y F%V[RIONMENI AL SERVIC58-CE-RE" ISM 1,40RGAN RM. CERES CA 95:158 7.[19 5 'i-18+25 CALgQ0.S}3 BO <br /> ALTERNATE TSDF: <br /> rmn A❑ccut7;NEananer: 5nrr.Read <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the fallowing three boxes) <br /> M10',I 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 <br /> compiled with the regnlromenls of the applicable•Cellfornla used oil management regulations to daterm(ne this Is true.I agree to accapt the addlunnal charges far the disposal of this waste If <br /> the Information I have provided about this waste Id Incorrect <br /> ❑021 have not mixed any of the waste described above with any other hazardous waste,the Iota(halide content Is GREATER than 1,040 ppm,and the waste does not contain any Pcies. <br /> have provldad proper documen1allon to World'011 Environmental Services 10 rebut the presumption Met thfa waste was nixed with other hazardous waste.I agree to'Accept the additional <br /> charges for the disposal of this waste If the Information I have provlded about tills waste Is Incorrect <br /> Cl 43)This waste Is from a tank which collects waste oil from household"do-lt-yeumolf"(DIY)and/or conditionally exempt small quanilty generator(CESQG)sourc".To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank Is coley from DIY andlor CESOG sources.I have not mixed ims waeto oil with any other hazardous waste or waste oil <br /> from other source's.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 Individual signing In the Space set forth below on behnit at customer represents and warrants that halshe has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,rnarkad,and labeled,are ready for transpotlatlon in accordarxo with applicable slate and ledoral regulations,and that customer shall abide <br /> by the Standard TermS and Conditions on the reverse sada el this Service Order. <br /> Servico Orders with an associated hazardous waste manifest(c[the r site spec Ill c or c on s a[Ida(ed)aro sub]ocl to an EPA Fee.These fees cover the EPA pass-through fee and administration <br /> of the amen fact program. eSo fees vary based on Manifeal type. Applicable fees will appear on your bi Iing Invoice. <br /> Customer Signature Date br�av�er�Signature ? Date <br /> Print Name Print Driver Name <br />