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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: N3607541 <br /> 562-231-1550 GWORLDOIL <br /> ENVIRONMENTAL SERVICES.,. <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H SPEF_DEE OIL CHANGE 1-800-727-2879 <br /> P245 Vhf LOUISE AVE WWW.WORLDOILCORP.COM 245 W LOUISE AVE <br /> P <br /> ° MANTECA,CA 95336 TRANSPORTER EPA#CAD028277036 <br /> T MANTECA, CA 95336 <br /> o (2019) 325-5823 (209) 825-5823 <br /> 1122Z1(lp <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> SP 080 OUTS 12 ADAM SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 5/25t2021 5/19/2021 CAL000351460 0-29/!!S�26 /"zlt <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> PFO USED OIL/MIXED OILS 510 �3 <br /> BATC # <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF:_ASBURY ENVIRONMENTAL SERVICES-CERES, 1920 MORGAN RD.,CERES,CA 95358(209)641-1825,CAL000393680 <br /> ALTERNATE TSDF: <br /> Crass Streets: Account Manager:Sam Read <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> Zsfi)l <br /> ing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 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 /> compiled with the requirements of the applicable California used oil management regulations to determine this is true.I agree to acceptthe additional charges for the disposal of this waste If <br /> the information 1 have provided about this waste is Incorrect <br /> 0#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 <br /> have provided proper documentation to World 011 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 /> 0#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 DIY/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 oft <br /> from othersources.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 /> 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 theiorgoing 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 federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fe se fees cover the EPA pass-through fee and administration <br /> of the eManlfest program.These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br /> Customer Signature Dateriver Signature Date <br /> Z2 V cy1 OL8` I i �� -�r'AAe, <br /> Print ame Print Driver Name <br />