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FOR SERVICE CALL: SERVICE ORDER FORM NO . WOES004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER N0. 1 -800427-2879 FOR ACCOUNTING CALL: N3174347 WOC) RLDOIL 562-231 -1550 ENVIRONMENTAL SERVICES g 7300 CHEVRON WAY, DIXON, CA 95620 I PROT OUCH AUT O REPAIR. - PROV 10 1 -800-7v-2879 P 255 MOFFAT BLVD WWW.WORLDOILCORP.COM 2.55 IIMOFFAT BLVD P E TRANSPORTER EPA # CAD028277036 T NIANTEC& CA 05?.3ci M NTECA , CA 95336 0 (20:)) 739 . .4250 (203) 239-9250 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES PROI10 f ;OUTE 12, ' � , ALDO SCHEDiILEDl DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # 31yj`21020 21255120:?? CAL000299266 � ,t1 PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 1nlb5C USED OIL SERVICE CHARGE 1 $ x. 00 $G5* 00 WO USED OIL i tvil?',ED OILS 150 $0600 $O. pO 9r;TCl « TOTAL CASH RECD: CHECK 4L. WASTE DISPOSAL INFORMATION ti NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER : DESIGNATED TSDF: ASPI l8V F1111801' 1AfiF4 i GI ( Sit! ^CS !`FRES 1070 MORGA4 4r f`FRFC nk 4 tAgQ f9h402t 1n1F nal ALTERNATE TSDF: DRUMS P/U : EMPTY DRUMS: FACILITY: BSC U r/' GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRI BOXQZ� By s1 Ing below i hereby certify thet: Q (Waste oil generator/customer MUST check ONE of the following thr ss J01) I have not mixed any of the waste described above with any othsr hazardous waste the totaf haildo comont is LESS than 11000 ppm, and tho waste does not contain any P Pha eomp0ed with the requirements of the applicable Califomta used oil management regulations to determine this Is taro. ► agree to accept the additional charges for the disposal of this ta4 the Information I have provided about this waste Is Incorrect e2 1 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. l 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 charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 0 v3) This waste is from a tank which collects waste all from household "do.IPyourself" (tHY) andtor conditionally exempt smell quantity generator (CESOG) sources. To the best of my 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 all 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 (All generators/ customers MUST read the following text I certify that 1 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 practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment. This I as ring 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 and to Is ate a and acoutatoaspackaged, marked, and (abated are ready tar transportation in accordance with applicable staid and fedoras reguiatlonst and that customer shall abide by thoStmlda a and Conditions on the reverse side of this Service Order* saivlca do Ith an associated hazardous waste manifest (either alto specific or consolidated) are sublect to an EPA Those tees cover the EPA pass-through fee and administration aft est program* Thaea vary basad on Manifest typo. Applicable foes will appear on your Ming invoice. �n CustomerSignaturre Da et Dri nature � / s - f - Prinf N m Print Driver Name