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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 N3539218 <br /> FOR ACCOUNTING CALL: ()WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICESTM <br /> S 7300 CHEVRON WAY, DIXON,CA 95620 <br /> H SPEEDEE OIL CHANGE 1-800-727-2879 245 W LOUISE AVE <br /> P 245 VV LOUISE AVE WWW.WORLDOILCORP.COM <br /> E TRANSPORTER EPA#CAD028277036 MANTECA, CA 95336 <br /> tMIANTEGA,CA 95331 <br /> T 1209? 825-5823 <br /> 0 (209) 625-5823 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTA T NAME ORDER ETTAKENDBY HALIDES <br /> SpE080 OUTE 12 �0� I <br /> ADAM DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSSTOIMaEaRa35146p BILL of LADING/MANIFESTfi�+ <br /> 3/31'', 3/24/?02'I A � � �'v�7 <br /> PART# DESCRIPTION OTY UNIT PRICE QTY P/U TOTAL <br /> PEO USED OIL/ MiXEiJ OILS 55a <br /> �O0 <br /> 3AT:1 # ------ TOTAL <br /> CASH RECD: CHECK# <br /> i WASTE DISPOSAL INFORMATION <br /> ISTATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) <br /> OTHER: <br /> DESIGNATED TSDF: ASRURY ENVIRONMENTAL SERVICES-CERES, 1520 MORGANRD.,CERES,CA 55358(209)541-1825,CAL0003636 <br /> 80 <br /> ALTERNATE TSDF: <br /> Account Manager: Sam fZeaf# <br /> Cross Streets: <br /> DRUMS P/U: EMPTY DRUMS:- FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> iii <br /> By signing below 1 hereby certify that: <br /> enerator/customer MUST check ONE of the following three boxes) <br /> (Waste oil g <br /> l�k1)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 PCBs.1 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 /> r <br /> above with any other hazardous waste,the total halide content GREATER than 1,000 ppm,and the waste does not contain any PCBs. <br /> N2 1 have not mixed any of the waste described aebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> have provided proper documentation to World Oil Environmental Services to r <br /> charges for the disposal of this waste if the information I have provided about this waste is incorrect <br /> a <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 /> Soley from DIY and/or CESOG sources.t have not mixed this waste oil with any other hazardous waste or waste oil <br /> knowledge,the only waste oil contained in my DIV/CESOG collection tank is <br /> 1 from other sources.I agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text <br /> practicable and that I have selected the <br /> I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <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 /> Krd <br /> Ing 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 /> �i 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 <br /> erms and Conditions on the reverse side of this Service Order.ith an associated hazardous waste manifest(either site specific or consolidated)are subject to anEPA Fee. These fees cover the EPA pass-through fee and administration <br /> program. These fees vary based on Manifest type. Ap((pl��icable fees will appear on your billing invoice. 3 �} <br /> 3 3 /�" 121 Date <br /> �Cu tomer Signature <br /> Date Dri ignature <br /> �-p-1,i� M�/a/ <br /> Print Driver Name <br /> Print Name <br />