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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE n ` ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOESI)W-(; <br /> 1-800-7'27.2879 SERVICE ORDF{1 P1r r, <br /> FOR ACCOUNTING CALL: 00WORLDOIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICESa <br /> 7300 CHEVRON WAY,DIXON,CA 95620 ` r <br /> IPHIL I.JOI�1�.DAKIS 1-800-727.2879p 2507 U <br /> EDNE Rid WWW.WORLDOILCORP.COM <br /> TRANSPORTER EPA#CAD028277036 <br /> r E CALON. �,:A Wi <br /> (21M M-6 ISO <br /> CUSTOMER# PURCHASE ORDER-# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN 13Y -lf�t.IRII ; <br /> Erle <br /> DATE REQUIRED DATE.ENTERED NEXT SERVICE DATE CUSTOMOR EPA# BILL of LADINGI MANIFES'i <br /> - E <br /> PART# DESCRIPTION OTY UNIT PRICE QTY PIU <br /> DRAINED UW, J.L0#�►` L F�,� <br /> F10'E ;41r`FALr 4 - <br /> TOTAL ' <br /> CASH REC'D: CHECK#___-�_ �-�_ _ _-L.-- <br /> WAS <br /> T <br /> ,-- <br /> WASTE DISPOSAL INFORMATION — <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED 61WIXED OILS <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODSTATE E 221 <br /> OTHER:, -. <br /> DESIGNATED TSDF: i11411au r L}l�15iF � — — <br /> ALTERNATE TSDF- <br /> DRUMS P EMPTY DRUMS: 88C <br /> FACILITY: -- r <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby omtity that- <br /> (Waste oil generator/customer MUST check ONE of the fallowing three loxes) <br /> G 1 pi I have not m�Any of the was" �used oil nagomon regrege Usti n@ to ddatemine th�xtntU46 then <br /> e t 1AM�and U»Was"`loss""t°°"941{1 ally pct e..t I,. .. <br /> L1 ol)I h With the Ir any <br /> o ft a the with <br /> the information 1 have provided shout"do waste to Incorrect tttlt�s to aoeApt rhe addhlorml chargee for lite ditglpe.al,Pt thej wz­�l n <br /> ❑021 have not mixed arty of the wallas detsoHttad above with any ostler hazardoue trdtNoto u ,the total ftalie,k eontont Is QR@ATER thmr+.Q:9 >1,-aexl Nte waste-boo Iwt Loaf rb1;my <br /> have provided epoem of this wasta N theme Oil have al provided about flet wit waste is innplloatiflat 1hFs wuW sells mlxad with r.1„r,h..,.nioc waue,.I nUruo to 0'")t tlw., <br /> charges for the dlrob t <br /> p <br /> l]/3)This waste is from a tank which eolleols waste oil from household"do-tbyouraw(Day)and/or oordltionsity axenrpt amaa"arttny generator(01113W)aonrcca.'i o gl"f,,..l..r tuv <br /> knowledge,the only waste oil contained In my IMCEBQQ awk atlon tank Is solay from DIY mXV0f CE808 sauroae.I bevel nae mixed Mayradm oil with alln*dy utl . <br /> from other eoaroes.I aims to 0006W the addWonal ohargm for dEsposai of this waste N the Info w ntatlon I have provided m 4mA ills veal a I„� wr hnzan x>uc W-:,, <br /> (Ail generators/customers MUSt read tfttr tt aWing text <br /> I cortlly that I have a program in piece to raduoe the volume and toxicity of Wallis generated to the dogrea I have d4twmined to be eaonantlasay#ractleabao aril titat I lulvc Jow-.1 use <br /> pr'eagonbl0 method of trooMmt,stomp.or disposal ounu tly available to me which minimime tem present and future thwot as hwymn Will end the enviromnaat. <br /> This Individual scald 10 in the°papa est forth below an behalf of ouetomer rolr+eeents and warrants that he/she has the <br /> and mateetals are and accurate to peakatged,matuod and ktbeled,aro reedy for transportation in n000rdanoe with�Is�bktd eseer+tnar,ur-d Nta fot;pin�i dsscriptimar.or w».l. <br /> by dee Standard Yonne and Conditions on the reverae aide of thio Bervloe Order. °t>ai stall PW fe deral regulaamte,mxl that ced06 mals etuilf.�,H> <br /> Service Ordara with an aseoclatod hazardous waste manliest setter site <br /> Of the OlNanifeet program.Thaw fess vary based on ManNaet� Opealfa0 or oonsolidatsd)aro suhiamt to an CrpA F..- i.i.,.,,„,r trw ehA tom..-1u•�,.{tr,r.,...,.,.{�,{•nl.,lr,.,.w�w. <br /> type. Appltaable Tose will appear a1 your bffnhlg invo[oe. <br /> oinC�M1 " tr i • L— �� <br /> erSigna�ture Dante <br /> - r 81oeaI r, <br /> 11-Tritit Name <br />