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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-B(8/18) <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: N3537532 <br /> 562-231-1550 OWORLDOIL <br /> S <br /> ENVIRONMENTAL SERVICES- <br /> ", SPEEDEE OIL CHANGE 7300 CHEVRON WAY, DIXON,CA 95620 <br /> P 1-800-727-2879 <br /> P 245 Vhf LOUISE AVE <br /> E WWW.WORLDOILCORP.COM 245 W LOUISE AVE <br /> TRANSPORTER EPA#CAD028277036 <br /> T MANTECA, CA 9' 336 MANTECA, CA 95338 <br /> (209) 825-5823 <br /> (209) 825-5823 <br /> PDATEREQUIRED <br /> PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> CER-86 <br /> istanton <br /> DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 3/18/2021 CAL000351460 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF USED METAL OIL AND GASOLINE FILTERS 3 $0.00 If $0.00 <br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 3 $0.00 3 $0.00 <br /> BATC # <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: k(*Wlk 4 11 �ARGGLIS WASTE-,SOL!E)(FILTERS CONTAINING I�Q.) SIAT G013 22 — <br /> DESIGNATED TSDF: <br /> ALTERNAT F: S,111E 00044300 <br /> AcaQunt Manager Sam Read <br /> DRUMS P/ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below 1 hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> J#1)1 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 PCBs.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if <br /> the information I have provided about this waste is incorrect <br /> J#2 1 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.1 <br /> 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 <br /> charges for the disposal of this waste if the information I have provided about this waste is incorrect <br /> J#3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIV/CESOG collection tank is soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil I' <br /> from other sources.I agree to accept the additional charges for disposal of this waste if the information 1 have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text tt <br /> 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 <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> 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 <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and fed <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. federal regulations,and that customer shall abide <br /> !} <br /> #fe <br /> rs with an assoc ated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration t <br /> i est pr ra . Th se fees vary basedon Manifest type. Applicable fees will appear on your billing invoice.OLT <br /> I nature Date / /� <br /> i ignature Date y <br /> Print Driver Name ` <br /> r <br />