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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) DIXON OFFICE r ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: O &D OIL visa 562-231-1550 ENVIRONMENTAL SERVICES., S 7300 CHEVRON WAY,DIXON,CA 95820 "l PHIL.LIONUDAMS 1-800-727-2878 2507 JONES RD WWW-WORLDOILCORP.COM 25071 Iw JONES RU E D TRANSPORTER EPA#CAD028277036 T ESCALON, CA 85320 ESCALON, GA 95320 0 =9)8$8-8150 01838-8150 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES 2' 81 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING!MANIFEST 9 PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL OF DRAINED USED OIL.&GA UNE- I-ILTER.S(METAL) 2 5�. - OfiDR CNS..FILTER DRUM REPLACEMENT - IriEt7 C 4# E $55 2 110.00 k TOTAL CASH RECD: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: .�r i# -- - .� :. lR DESIGNATED;TSDF: ALTERNATE TSDF: 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) ❑01)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LEW than 1 AM ppm,and the waste does not contain any PCBs-t have compiled with the requirements of the aWleabie California need oil management reguistlons to determine this la true.I agnea to*sept the additional charges for the disposal of this waste It the information 1 have provided about this waste Is lnoorrsat ❑#21 have not mixed any of the waste described above with any other hazardous waste,the total haikht content Is GRP-ATER than 1,000 ppm,and the was%does not contain any PCBs,t have provided charges for the roper documentation to World Oil Environmental Services to rebut the presumptich that this waste was mixed with other hazardous wants,I agrae to sa»pt the additional posal of this waste If the Information I have provided about this waste is incorrect J 43)This waste Is from a tank which collects waste,oil from household"do-it-yourmsii"(DIY)andfor condltkmsily exempt arra4 quantity,generator(CUSOO)sourosa.To the beat of my knowledge,the only waste oil contained in my AIW CESOt3 collection tank Is*clay from DIY anNor CESOQ sources.l haw not mixed flus laasta oil with any other hazartous waste or waste oil from other sources.I agree to accept the additional charges for dispomal of this waste It the Information I have provided this waste is incorrect tie (All generators/customers MUST read following text I certify that 1 have a program In piece to reduce the volume and toxicity of waste generated to the degree I have dmtennln*d to bra ec rlomicalty practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human iii*and the environment. This Individual signing In the space set forth below on behalf of customer represents and werrenta that IW*hm has the suthoAty to bind customer,that the fo nn0g ft and a Sha ala aro true and accurate e,5 packaged,the re marked,and labeled,are ready for trenaporWon In nccordanoe with applicable lasts*rid federal rogulationfa�aind that customer er shallli aabrae by the Standard Farms and Conditions on the reverse cede of this Service Order, Service Orders with an associated hazardous waste manifest(either silo=lc lc or consolidated)are subs to an EPA Fes. tip cover the EPA pass-through fee and administration of the eManhtest program.Thane tars vary based on Manliest type. Applicable fees wilt appear on your billing Invoice. Cue omer Signature Date ver Signa Date Int Name Print Driver,Name