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i FOR.SERYICE CALL, SERVICE 0RQER FORM NO,woEsoo4 i3(ar18) DIXON OFFICE ASBURY ENVIRONMENTAL.SERVICES, DBA 1«800-727.2879' SERVICE ORDER NO; FOR ACCOUNTING CALL; �Q�� L N3617317 562-01-1650 ENVIRONMENTAL SERVICES, 7300 CHEVRON WAY;DIXON.CA 95624 FIRESTONE#02871l� �-soo-7z�-2e7s QUEST RE"' URGE MGT-FIRESTO ? 720 E. HAMMER LANE 3481 PLANA PARKWAY WWW.woRLPOiLCORP,.COM E TRANSPORTER EPA#CAD028277036 T STOCKTON,GA 9 210 THE COLONY,TX 77056 (209) 951-2403 !9721 464-0004 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME" ORDER TAKEN BY HALIDES FIR627 'ROUTIE 12 Z/OR SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE' CUSTOMEWEPA'# BILL df L4Plq1 &4/2021 5;26/2021 CAL000366211 3a PART`# DESCRIPTION OTY UNIT PRICE QTY P/U. TOTAL PFO USED OIL I MIXED OILS 1811 8ATCJ TOTAL, CASH REC'D;= CHECK WASTE DISPOSAL iNFORMATiON NON»RCRA HAZARDOUS WASTE,LIQUID(USeO OILIMIXED OLS) STATE.CODE 221 NQN=RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE QLYCQt.SOLUTIONS) STATE CODE OTHER' DESIGNATED7SDF;, ASE3URt'EIWIRON Ei A SE 1C C S S GAN. 90 ALTERNATE T81JF; :. A�cgurt Mangy er:SamRa�. ," DRUMS PN EMPTY OR FACILITY. 8SC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) by slgnlnto below I hereby certily that: (Waste oil generatorlcustomer MUST check ONE of the following three boxes) Af)I have not mixed any of the waste described above with any other hourttous waster the total It"content m LESS thud 1,000 ppm.and the waste does not contain any PC$a.t have -6110,104 with p1g retiuiremants of the applicable California,-used oil management r,W;!fioits to determine fibs to true.I agree to accept the additional charges for the disposal of this We It the information I have provided about this waste is Incorrect J e21 hays not mixed any of the waste described above with any other hazardous waste,the total halide content le GREATER thein t.mto ppm,and the waste does hot contain any PCA$i I have provided proper documentation to World Oil Ernhronrnentai Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the'addHional charges fpr the disposal of this waste if the Information I have provided about this waste is incorrect C,03)This waste i9 from a tank which collects we oil from household"do h•yaurseM"{plYj and/or condHioneily exempt small quantity generator tCEStiG)sources To the best of my knowledge,the only waste ori,contained in my Q1W CE$QO collection"nit Is"ley from Ply amuor PAS,"aources.i have not mixed this waste oil with any other hazardous waste or waste oil from minor sou e t a9nm ApeGoopt the epditionai charg"for.olapoaai of this wahito if tiro informispon1 neve provioc about thia.waste is Incon vat (Ail generators/customers MUST read the following text I""fly that I he P ogrant In place to reduce the volume end toxicity of waste gone tali to the degroe l have detarmined to be economicauy practicable and thea f have selected the practicable met f tment;storage,or disposal currently available to which m lmlzas the present and future threat to human life and the environment. Thm ihdivtduai g the spaooset torch below on behalf of ouatomer relrresanta and vrairante that heAitte hes the authority to bind oustomer,that the forgoin denariptlons of waste and for late d acoui'e as packaged,marked,and labeled,aro ready for transportation In accordance with applicable state end federal regulations,ani!that customer shah abide nda d Con'Mons onthe reverse aide of this Service On:14'�1 Sery a hazardous waste manifest(sither alto specific or consolidated)are subiect to on EPA Fee.T ss fees cover the EPA pose through foo and administrotlon+ aft as an Tttase 'a based On Manifest type.Applicable This Will appear on)rout bbiiilling invoice, Custoirter� aij r Date Driver Signet re bate. Print Name tint Driver Name