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_r R SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES DBA <br /> SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: W®��® ®'L N3626454 <br /> 562231-1550 <br /> ENVIRONMENTAL SERVICES,. <br /> S7300 CHEVRON WAY,DIXOU,CA 95620 <br /> I SPEEDEE OIL CHANGE 1-800-727-2879 <br /> P 245 W LOUISE AVE WWW,WORLDOILCORP.COM 245 W LOUISE AVE <br /> TRANSPORTER EPA#CAD028277036 <br /> T MANTECA, CA 95333 MANTECA, CA 95336 <br /> e (209) 825-5823 (209) 825-3823 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> SPE080 CER-86 istanton <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 6/412021 CAL000351460 <br /> PART# DESCRIPTION . QTY UNIT PRICE QTY P/U TOTAL <br /> PF ` - 'PAPER FILTERS PER,DRUM 1 $85.00 $$5.00 <br /> OfiGR ,QIL FILTER DRUM REPLACEMENT NO CHARGE- 1 $0.00 * $0.00 <br /> tATCF# <br /> �. TOTAL <br /> CASH REC'D: CHECK# " <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER:_ NioN-ar:RA HA7ARnni ifi iArA,-�-rF,SOI In(Qif V F1lPPRIRI A.ST'in FIi TFF2S 1 rIF8rzt8,) smto f`Otuxy;q <br /> DESIGNATED TSDF: YES MANAGEMENT,INC:,6500 I ISHIGHWAY95,YUMA,AZ 85365 <br /> ALTERNATE TSDF: I 'i <br /> Crass Streets: Accaunt Manager:Sam Read <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil g6nerator/customer MUST check ONE of the following three boxes) <br /> 0#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 t 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 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 /> #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.'ro the best of my a' <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or Waste bll <br /> 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 /> 4g j' <br /> (All generators/customers MUST read the following text <br /> I certifX ftp ve a progEam in placelb'reauce 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 t I qd of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human t(te 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,masked,Old 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 Fee.These fees cover the EPA pass-throughlee and administration <br /> of the eManifest program.These fees-vary based on Manifest type.Applicable fees will appear on your billing invoice. <br /> C( ,t uusstomer Signatureoi <br /> Date D --er Signature / Date <br /> Print Name Prliltt6river Name <br /> �` u <br />