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2309 West Hammer Lane PR0546737 <br /> September 2, 2021 Program: HW <br /> PHOTO 1: Consolidated manifest missing manifest number. <br /> FORSERVICE CALL y SERVICE ORDER - <br /> DIXON OFFICE FORM NO.WOES004-B(8/18) <br /> -.00.727-2879 ASBURY ENVIRONMENTAL SERVICES,DBA <br /> SERVICE OflDER NO. <br /> CCOUNTING CALL: <br /> y, ` 31-1550 O WORLD OIL <br /> s ENVIRONMENTAL SERVICES, <br /> 7300 CHEVRON WAY,DIXON.CA 95820 <br /> 1-800-727-2879 <br /> n �- ! ( i rr'•.flE� WWW.WORLDOILCORP.COM <br /> TRANSPORTER EPA#CAD028277036 it1CT <br /> o . UI�'r;.i�,rJ <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# 0 <br /> BILL of LADING/MANIFEST# <br /> li PART# DESCRIPTION Ory UNIT PRICE Ory P/U TOTAL <br /> ( I <br /> I( <br /> TMI RECD: CHECK# TOTAL <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL MIXED OILS) <br /> I NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS STATE CODE 221 <br /> OTHER: ) STATE CODE_ <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: . .. <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: <br /> BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> BY clgnlny below I berobY cadity that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> mplletl wllM1 marequlnmantabol the ePPllcebeC.1dan.la lased oil imanagemrenturegulatllonaeto tlellerm11 ne this lahaitlrue.E agrast1,XhAptiheahAth atad...A.tthe tlisin any RCBe.l have <br /> Ne Inlormatlon 1 have provitletl about thio waste Ic Incortect poeal of this waste It <br /> ❑#31 M1ave not mlaetl any of nt-wail.d.inint ed above with any.,ber hezeMous waste,iM1e total halitle torrent Is GREATER Then t,g06 ppm,antl the waste tloes not contain any PCBs.I <br /> have p.I.,In proper tlotumenmllon to Worltl 011 Envlro=-I Servltta to rebol IM1e preeumptlon that thio wash was mlaetl whh otM1er M1aaartlous waste.agree toettapt the etldhional <br /> charges for me dlapA..,of mla waste 11 ins lnformalion l have provitletl about tM1ls waste lc lncorrem <br /> The <br /> ❑agl dge,waale fly Irom a 11 ii which collects weals oil Iron h 1,ahold"tlo-lt-yourself"(DIY)endlor conditionally exempt small quantity generator IDEBDG)co sea.To the at of my <br /> knowledge,a.only waste oil contained In my DIY/CES 11*collection tank Is coley from DIY and/or CESOG sources have not mlaetl INwaste oil with any other M1auMoue waste or waste oil <br /> Irom otM1er tourcea.I agree to accept the aedidonel chargee for disposal of thls waste If the Information I have P1.0ded at o IN......la Incorrect <br /> (All generators/Customers MUST read the following text <br /> 1 wnlN DIN I Mw a pr.i In place m reduce the volume and t ith,of waste generatetl to iha degree I have tleterminatl to be econamlcally practicable and that I have aelectetl the <br /> mlNbla maNad of iroabnenl,storage,or disposal-.many available to me Whitt minlmlzes the present antl future threat to human Ills and the environment. <br /> Id l atoning In the apace eel lorlh below on behalf of customer represents and warrants that he/she hes the authority to bind customer,that the forgoing tlestrlptlons of waste <br /> ltan arohw and accurateas pecMagetl,marNed,antl labeletl,are reatly for[ransporlatlon In accortlanca with applicable state and laderel requlagone,antl that customer shall eblda <br /> 9bndard Tarma and Contlitlona on the reverse sitle of this Service Order. <br /> oservin.rdary with an eaeoclatatl hazardous waste manifest(Ithar aIle specific or consolidated)ere s b�ect to en EPA Fae.These lees covsr the EPA <br /> I Iha gi/nlNal -grem.Thaae fees very baaetl on Manifest pa�.s-miougM1 lie and cdmir!slmt!on <br /> type.ApPllcabta fees will appear on y..rrb lling invoice. <br /> Cue omerSlgnature /—/— — <br /> Date Driver Signature------ ----/-- /— <br /> Date <br /> Print Name - _ <br /> Print Driver Name --------_--_--- <br /> Lydia Baker, SR. REHS Page 1 of 12 <br />