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FOR SERVICE CALL: ,SERVICE ORDER FORM NO, WOeS004.8 (6/18)
<br /> DIXON OFFICE () ASBURY ENVIRONMENTAL, SERVICES, DBA
<br /> 1 -8DQ�727.7�79 p A i SERVICE ORDER N0.
<br /> FOR ACCOUNTING GALL: 0WORM011a.587-2x1 -1550
<br /> ENVIRONMENTAL StRVI.OESra
<br /> FI7300 0HtVFtON WAY, AXON, CA,95520
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<br /> KJft: ' I" h ! ^.11t �1•f1�,1, C :n.Ft c /+ IJt: • '_' tics 1 •eoo-727-2679
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<br /> P WWW,WORLDOILCORP,COM
<br /> TRANSPORTER EPA # CA00198211038
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<br /> CUSTOMER # PURCHASE OR6ER # ROUTE # I TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES
<br /> u. tib,r. +6 tl.3L,! ! 'k; 1 ,, Iti1wI7F1d+CltFril ::,
<br /> DATE REQUIRED DATE ENTERED NEXT 8ERVICE oATE . CUSTOMER EPA A BILL of LADING! MANIFEST 4
<br /> Ali:; w, . ,
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<br /> PART # rr DESCRIPTION QTY UNIT PRICE QTY P/U I TOTAL
<br /> AI' ANANNN
<br /> P1,t./r1: 0ALL N10R FOR INST'Ri)( 111, tt'. " r+)). 'rlh• I? ,> tr) flttrC;rl iS N_ __ --
<br /> TOTAL
<br /> CASH REC'D: CHECK #
<br /> WASTE DISPOSAL INFORMATION
<br /> t40t AN NON•RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221
<br /> 16
<br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE t0�
<br /> OTHER:
<br /> DESIGNATED TSDF• hVOM- D ( SII. F: M,Tt4< rNMI: Pd9:41 , SI •vt; t^ ! '. Fdfpl, . 11� ?Il M+ tltr'S4N l ; l.t C:t ! ttn ; ( , :e ' . 1hH 2O1a t.ti • It1 !S , 1 .A4i111U111 � Fl0
<br /> ALTERNATE TSDF: w
<br /> (':rCT.��� itY44f?�; �. r� ttlni A9t1ta;J�' "Sam kexi
<br /> DRUMS P/U: __ EMPTY DRUMS: FACILITY:
<br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX)
<br /> By alpnhtp below I hereby emlify Nal:
<br /> (Waste oil generator/customer MUST check ONE of the following three boxes)
<br /> © #1) 1 have not mixed any of the waste detcrlbad above with any other hazardous walla, the total halide Content Is LEGS than 1,00 ppm, antl but wash does not Contain any P08#. I haw
<br /> oompllod with the reguitementa of the applicable California used all management regulations to determine thio le true. l spm to Wept the Additional chars" for the disposal of this wool* If
<br /> the Information I have provided about this wash Is Incorrect
<br /> Q #21 bave not mixed any of the waste described above with any other hazardous waste, the total halld# cordiM Is GREATER than 1,000 ppm, and the waste does not contain any Pool, I
<br /> have provided Propar docdmentatien to World Oil Environmental Servlcaa to rebut the preaumption that this waste was mixed with other hazardous waste, ) agrev 19 eocspt the Additional
<br /> 01rg" for the disposal of this waste I1 Na Information I have provided about this Wells Is moonset
<br /> ❑ #J) This waste la tram s tank which eollsote waste all from household "do44yourseti- (DIY) amitor Candlflonally exempt small quantity generator (CESQD) eoureas. To the beat of my
<br /> knowledge, the only waste oil contained in my DIY/ CES00 collection tank to soley tram DIY andlor CE800 sdurasa. I have not mixed this waste oil with any other hourdoue wait# or waste all
<br /> Flom other lot"#& i Was to 8004111 the additional olfarg#s for d(spoeal of No waste !( the Information i have provided about this waste Is Incorrect
<br /> (All generators/ customers MUST read the following text
<br /> I unify that l haw a program to place to roduce In# Volume and loxiOhy of weateenerehrd to the degree I have determinate to be onomfoally PrsOtisabte w and that I ha "Ikhd the
<br /> ProotitiAbie method of tre4iment, storage, or disposal outrantly available to ins which ro
<br /> ch maikmixes the Pre"nt and future thrum to human life and the anvironment
<br /> Thio Individual al ning In the space set forth below On behalf of customer ropraaenle and warrant# that he/4h4 hes the authority to bind customer, Nat the forgol d"ariptiona of Wpto
<br /> and materials are No end seeurale as psa Aliad, marked, and labeled, ars ready for tranwrteuon In aocordano# with applicable state and federal r#gulatlons, and that customer shrill #bid#
<br /> by the standard terms #no Conditions On eta WM s aid# of this gervice Order.
<br /> dervice Order& with an associated hazardous wools manifest (teither site aPealna or oonooiidstad) am oubt#et to an EPA ps4. These love oowr the EPA paM4tuaush fee And administration
<br /> Of the OManifest program, The" t"s vary based on monlfsetlypa, Applioabls ("a win "Air on your b(Iikls lrwow.
<br /> LL\ FIN
<br /> ` Customer Slgnatuta Date Driver Signature bili
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<br /> plim Bill 1111
<br /> A Nip
<br /> V0 39vd d0 2itl0 1VN0I1VNd31NI 8I9L89E60Z 0Z : 6L >; Z0Z / 8Z /0L
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