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M O) -0 <br /> o ; `D ONS <br /> NNS X000 <br /> -n N N O <br /> O O O :* On <br /> v pp N CO <br /> Q W O <br /> � O v <br /> O N ' 5CD cn <br /> O <br /> IN) O O <br /> _ Page I NO0- 4�- <br /> N <br /> N (3T <br /> CO Q <br /> M <br /> FOR SERVICE CALL: a N <br /> I DIXON OFFICE SERVICE ORDER g/18) N 0) <br /> 1-80D-727-2879 ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES004-8( — O Z <br /> NO O <br /> SERVICE ORDER NO' <br /> FOR ACCOUNTING CALL <br /> N N <br /> 562-231-1550 ot WORLD OIL <br /> C5 , <br /> - <br /> 7 <br /> � � cCIDi r <br /> i' ak s ENVIRONMENTAL SFRVICES,,. N CD c <br /> O-5 3 <br /> H 7300 CHEVRON WAY,DIXON,CA 95621) 3 N (D <br /> I <br /> ! P 1-800-727-2879 CD O <br /> E WWW_WORLDOILCORP.COM <br /> D TRANSPORTER EPA#CAD028O Q CD <br /> 277036 cn =5 (D Z) <br /> T O <br /> N 3 C- <br /> O <br /> CUSTOMER# PURCHASE ORDER Cn <br /> # ROUTE# TRUCK# CONTACT NAME =LADING1 <br /> O N(Q < <br /> < <br /> O <br /> O (D W <br /> DATE REOUIREp PATE ENTEREp NEXT SERVICE PATE C05TOMER EPA# _ <br /> - N � � p <br /> -0 O9 0 n <br /> (D 7 _77 <br /> c O <br /> PART# DESCRIPTION C :3QTY UNIT PRICE QTY PQ IU TOTAL � � _ <br /> N O O n <br /> o D <br /> ry <br /> N 5_ m <br /> 1 <br /> 0 (c <br /> cn � <br /> v, m <br /> (D <br /> TOTAL Q <br /> CASH RECD: CHECK#_ O. 00 <br /> WASTE DISPOSAL INFORMATION <br /> ,C NON-RCRA HAZARDOUS WASTE.LIQUID(USED 01UMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> ;r� f <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> 8y sfgnfng below I hereby wrtify Ihar: - <br /> (Waste oil generatorlcustomer MUST check ONE of the following three boxes) <br /> J xl)I have not mired any of the waste described above wllh any other hazard...waste,the total halide content Is LESS than 1,000 ppm,and the waste does nut conwin any PCRa.I have <br /> C eomplled with Ifra requirements or the applicable Callorno.sed oil management/ego lens to del.rmi i.this Is true 1 agree t.accept the lentil charges fur th,dcvpcsal of this waste If <br /> the Intormati.n I have provided about thio waste Ia Inwrreel <br /> J 421 have ncl oozed any of the weate described above wllh any other hams-sous waste,the total halide content is GREATER than ima ppm,and the waste does net contain any PCRe.I <br /> have provided proper cl—mentation to world Oil Envlronmenlal Sill...to rebut the presumption that this waste was mined with other havardeus waste,I agree m acceptor.eddltlonal <br /> �r charges for the disposal of this waste If the Informatlon I have pravldad about Ihfs waste Is Incorrect <br /> x3)This waste le from a lank which collects waste ok from household"do-R-yeurselr(Il and/or wndlhonally—.rpt small ri lly generate*(CESOG)sources.To the beat of my <br /> knowledge,rhe only waste oil contelned In my DIY/CESOG collection lank Is..toy from oly anElor CESOG sources.I have not mixed this waste off with any other hazard,us waste or waste.11 <br /> t from other sources.I agree to accept the additional charges for disposal of IN.waste it the Information I have provided about this waste is Inemrecl <br /> (All generators/customers MUST read the following text <br /> 1 Cenlly that I have a program in piece to reduce the volume and toxicity of waste consisted to the degree I have determined to be economically practicable and that i have selected the C <br /> .end pia C[luble method of treatment.storage.-disposek currently available to me which minimize.the present end Mule threat to human life and the environment. (D <br /> This Indlvldual signing In the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer,/hal Site forgairig d05crlpfigna el waste O <br /> by[orroll am troar and he Standard Terme anaaccurate as pa 1 igeel.marked, <br /> s.cede o and <br /> Iia Slev,Iam ca Older.for transportation In accordance with applicable state and federal mgufaSlone,and that customer shall abide Q <br /> .. ` Serve_Order.with an associated here....wast.mantles!feithor alis specific or canaolldaledl are sublael to an EPA Fee.These lees cover the EPA pass-through See and administration <br /> of the sl9enifea program-These fees vary based an Mail type.Applicable lees will appear on your billing Invoice- <br /> _ N <br /> v CD <br /> Customer Signature Date Driver Signature Date C O <br /> CQI.I On (0 <br /> N [ Print N813110Print Driver Nal W <br /> On <br /> O �� O <br />