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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: 562-231-1550 GWORLDOIL ENVIRONMENTAL SERVICEST. S 7300 CHEVRON WAY,DIXON,CA 95620 H 1-800-727-2879 1 P P 5 1-OU AV7- WWW.WORLDOILCORP.COM 245"11 UH S F. AVE D TRANSPORTER 24W - E TER EPA#CAD028277036 TCA C-5336 0 N1ANTE'-A,C,,A 953kL, (209" €I^S- "3 2'9) 6,25 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES SPE080 10UTE 12A�M[ ADAM 53 Ci-i Ei�)'%J L'E'Iai-1 DATE'REOUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 2/23/20212117/2021 CAL000351 460 I - I I PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL PFO UISED OIL/ MIXED OILS 475 45n RATC11# TOTAL CASH REC'D: CHECK# 'dq WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 �NOWRCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: AbdUKY ENVIKONMENIAL ALTERNATE TSDF: St:KV1U:S;Uk:KtZb, 7920 MO RU�,r.;I:Kt5,UA-Vb�tf(/-UV)b4T-1 tUb,CALCUU39 ftcount Mariager$3rn Read cross sTeerts: DRUMS PN:- EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By fining below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) Z)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 PCSs.I have compiled with the requirements of the applicable California used off management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect Ll#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 ❑#3)This waste I is from a tank which collects waste oil from household"do-ft-yourself"(131Y)and/or conditionally exempt small quantity generator(CESOG)sources.To the beat of my knowledge,the only waste oil contained In my ON/CESOG collection tank Is coley from DIY and/or CESOG 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 it 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 I have determined to be economically practicable and that I have selected the practicable method of treatment,store",or disposal currently available to me which minimizes the present and future threat to human life and the 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 descriptions of waste and materials are true and accurate as packaged,marked, and labeled,are ready for transportation In accordance with applicable state and federal regulations,and that customer shall*bids by the Standard Terms and Conditions on the reverse side of this Service Order. Ice 0 rs Ith an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee fees cover the EPA pass-through fee and administration of ema 'fe P Th fee vary based on Manifest type. Applicable fees will appear on your billing Invoice.pr' /4( tom ignature Date iffv6r signature Date Print NaPrint Driver Name