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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOE8004- 13 (8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA SERVICE ORDER NO. <br /> 1 -800-727-2879 <br /> N3530425 <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562-231 -1550 <br /> ENVIRONMENTAL SERVICESW <br /> s 7300 CHEVRON WAY, DIXON , CA 95620 <br /> " PROTOUCH AUTOrREPAIR 1 -600-727-2879 <br /> p 255 IVIOFFAT BLVD WWW.WORLDOILCORP.COM 255 MOFFAT BLVD <br /> E TRANSPORTER EPA # CAD02B277036 <br /> MANTECA, CA 95036 MANTECA , CA 95336 <br /> (209) 239-9250 (209) 239-9250 <br /> CUSTOMER #' PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> PRO110 ROUTE 12 . ALDO Vbernai <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADINGI MANIFEST # <br /> 3/11 /2021 CAL000299266 <br /> bt ► � � J � <br /> PART # DESCRIPTION 7220 <br /> UNIT PRICE QTY PIU TOTAL <br /> WOSC USED OIL SERVICE CHARGE $ 160 . 00 $160. 00 <br /> IWO USED OIL / MIXED OILS $0 . 00 ' � $0400 <br /> 8ATCr ;r <br /> TOTAL <br /> CASH RECD: 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 : <br /> DESIGNATED TSDF: A8811g'EPNIgoVAENTAI SFRVIC S-0CmRFB j920W0RGANRna rFAes (`.A 95159 (209)541 tA25 CAL000393680 <br /> ALTERNATE TSDF: <br /> Qrncc r,hra�*c - Account Manager, Sam Read - <br /> DRUMS P/U : EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below thereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> t st) 1 have not raised any of the wasia described above with any other hazardous waste; the total halide content is LESS than 11000 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. 1 agree to accept the additional chargee for the disposal of this waste II <br /> the information I have provldod about [his waste Is Incorrect <br /> ❑ #21 have not mixed any of the waste described above with any other hazardous waste, the total halide content Is GREATER than 1 ,o 0 ppm, and the waste does not contain any PCBs. l <br /> have provided proper doeumematton 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 /> C3 #3) This waste is from a tank which Collects waste ell tram household "do•lt-yourself' (DIY) and/or condItlonally exempt email quantity generator (CESOG) sources, To the beet of my <br /> knowledge, the only waste oil chmalned In my DIY/ CESOG collection tank to soley from DIY andfor CESOG sources. I have not mixed this waste oil with any other hazardous waste or waste oil <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 /> (All generators/ customers MUST read the following text <br /> I certify that 1 have a program In place to reduce the volume and toxicity of waste generated to the degree 1 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 minlmlzes the present and future threat to human life and the environment. , <br /> This Individual signing in the spaca aot forth below on behalf of eustamor represents and warrants that helshe has the authority to bind cubtomor, that the forgoing descriptions of waste <br /> and matoflais are true and amrato as packaged, marked, and !abated, aro ready for transpottalion in accordance with applicable state and federal regutaltons, and that customor shall'$bids <br /> by the SlaodardToone and. Conditions on the rovorao side of this Sarvica.Order. - <br /> Service Orders with an associated hazardous waste manifest (either site tpeciflc orconsoiidated) are subject to an EPA Fee. These fees cover the EPA passthrough tee and administration <br /> of the oManllostprograrn, Thaae !eos besodonManifest type. Appgoablefees will appear onyour blllndInvoice. <br /> Y - 0 'dol 3 , 3 4 � 2( <br /> ture Date ver Signature Date <br /> Customer Cgna <br /> ? r � <br /> Print Name Print Driver Name <br /> i <br />