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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-B(8/18) 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: N353%S3 562-231-1550 OWORLDOIL S ENVIRONMENTAL SERVICEST. 7300 CHEVRON WAY, DIXON,CA 95620 SPEEDEIe OIL CHANGE 1-800-727-2879 E 245 W LOUISE AVE WWW.WORLDOILCORP.COM 245 W LOUISE AVE T MpNTECA, CA 95336 TRANSPORTER EPA#CAD028277036 ° (209) 825-5823 MANTECA, CA 95336 (209) 825-5823 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES SPE080 CER-813 �j ista�,ta�, DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 3/18/2021 CAL000351460 PART# DESCRIPTION PF PAPER FILTERS PER DRUM QTY UNIT PRICE QTY P/U TOTAL 1 $85.00 OFt.)R OIL FILTER DRUM REPLACEMENT- NO CHARGE $85.00 1 $o.oo � $0.00 BATG # TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: _ DESIGNATED DF: ALTERN DF: IIGHWAY 95,YUMA,,`_Z 84365 DRUMS P/ : EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) U#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 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 the information I have provided about this waste is incorrect 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 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 knowledge,#3)This waste is from a tank which collects waste oil from household is (D1Y)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my the only waste oil contained is my DIY/CESOG collection tankk from other sources.I agree to accept the ais soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil dditional charges for disposal of this waste if the information I have provided about this waste is incorrect (All generators/customers MUST read the following text [ 1 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 k practicable method of treatment,storage,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 abide by the Standard Terms and Conditions on the reverse side of this Service Order. Service Ord rs with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration of t e M n est p ogram These fees vary based on Manifest type. Applicable fees will appear on your billing invoic:�4 . /�/� /—L_/�./customer ignatur DateSignature Date print Na Print Driver Name