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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: i335'902 562-231-1550 WORLD O I L ENVIRONMENTAL SERVICES,. 3 J —f,`, t _� _, 7300 CHEVRON WAY,DIXON,CA 95620 H %„c 1 yr i':; .—.•�� \•�'� �i �. , e�i:� 1-$00.727 2879 AIN i CIN' N; E_:,J,1 LI'PF%1,S:-:-S LLC /N'% E WWW.WORLDOILCORP.COM D �,�OCLJTRANSPORTER EPA#CAD028277036 j <;L \, Wi05215 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL C RViC:W Cr,AR',E i OILS 285 0 TOTAL CASH REC'D: CHECK# r WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ASBURIV_NViR(_rl4AE:uTAL SERVICES-CEDES, 19217 MORGAN Rid.,C:EPES CA 95368 2W 54'i-1825,C-AL000393680 ALTERNATE TSDF: Account I'Vanager, Sarn Read DRUMS P/U: EMPTY DRUMS: FACILITY: BSG � GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) B sl rung below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) ni}1 have riot mixed any of the waste dencrlbed above wlth any other hazardous waste,the total hallde content Is LESS lli:in 1,000 ppm,and$he waste does riot contaln any PCBs.I have compiled with the requlrements of the applicable California used oil management regulnllons to delermine this Is true.I:;kyr ne to iceept the additional charges for the disposal of this waste It the Information I have provided about this waste Is Incorrect 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 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 Q #3)This waste is from a tank which collects waste oil from household"do-It-yourself"(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste all contained In my DIY/CESQG collection tank Is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil 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 (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 1 have determined to 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 threat to human life and tho environment. This Individual signing In the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing dascrlptlons of waste and nratorlals aro truo and accurate as packaged,marked,and labeled,are Toady for transporlaton In accordance with applicable state and lederal regulations,and that customer shall abide by Ilhe Standard Terms and Conditions an the reverse side of fhls Service Order. Service Orders wit n associated hazardous waste manifest(nither site specific or consolidated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration of the O nirrat g m. These fees vary based on Manifest type.Applicable fees will appear on your billing Invoice. `CLJd1C1meF61g4dkure Date Driver Signature Date ale'' • Print Name Print Driver Name