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FOR SERVICE CALL; SERVICE ORDER FORM No.waso04<E(sits) DIXON OFFICE ASBURY ENVIRONMENTAL.SERVICES, DBA 1.800.727.287 9 SERVICE ORDER NO. FOR ACCOUNTING CALL: N3684342 562-231-1550 ()WORLD OIL ENVIRONMENTAL SERViCESTM H FIRESTONE#028746 7300 CHEVRON VRON WAY,DIXON,CA sss o QUEST RESOURCE MOT-FIRESTC 1-800-727.2879 N 720 E. HAMMER LANE WWW WORLDOILCQRP.COMI 848'1 PLANO PARKWAY D TRANSPORTER EPA#CAD628277036 T STOCKTON,CR 95210THE COLONY,TX 77056 (209)951.2403 (972)464»0004 CUS,TOMER'# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN 8Y HALIDES ROUTEFIRM SCHEDULED-1 DATE REQUIRED DATE 99 ERI D NEXT SERVICE DATE CUEPA# MER BILL of LADING/MANIFEST# 6/13/22021 $14/2021 CAI OOI} 211 > "i526 9X11 jj/C- PART# 666RiPTiON QTY UNIT PR CE QTY P/U TOTAL PFO USED OIL,/MIXED OILS 27 0300 i I TOTAL CASH REC'D CHECK WASTE DISPOSAL INFORMATION XNON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE'000#221 � NON-RCRA HAZARDOUS WASTE,LiQUID(ETHYLENEGLYCOL SOLUTIONS) STATi=CQt)E OTHERa a XDESIGNATED TSDF: WORLD OIL EMARONMENTAi S &CERES. 1920 Mo_i GAN Rn CRFs.cAas35e a�1.t925.CA1 ani ALTERNATE TSDF: .. ._. tRead DRUMS P/U: EMPTY DRUMS: FACILITY: GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By gning below I hereby certify that; (Waste oil generator/customer MUST check ONE of the following three boxes) Nt)I hove not mixed any of the waste described above,with any other hazardous waste,the total halide content is LESS$than 1,000 ppm,and the waste does not contain any PclBs.I have compiled with the requirements of the applicable California used oil management regulations to determine this to true.i agree to accept the additional chargee far the dteposal of Ihia waste l the information 1 have provider!about this waste is incorrect LJ 1+21 Nave not mixed any of the wasto described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm;and the waste deal not contain any PCBs,i have provided proper documentation to World Cil Environmental,Services to rebut the presumption that this waste was mixed wuh other hazardous waste.I agree to accept the additional charges toe the disposal of this waste if the information i have provided about this waste Is Incorroot U 0)This waste is from a tank which collects waste oil from f ousehoid"do-it-yourself"(01Y)andlor conditionally exempt small quantity generator(CESM)sources,To the beat of my knowledge,the only-waste oil contalned in my VIY/CE840 collection tank is soley from CIY and/or CES46 sources..l have not mixed this*date oil with any other hazardous waste of waste olI tram outer sources,i agree to accept toe additional ct argas tar disposal of tuts waste if ilia unormation t nave promed spout thin waata to mounaot (All generators/customers MUST read the following text I I certify that i haves program In place to coduco tha volume and toxicity of wasta ganerated to the degree I have determined to be economically practicablo and that I have selected the ' practicable method of treatment,storage,or disposal currently available to me which minimizes the proaent and future threat to human life and the environment. This IndiVlduai algning in the space set forth below on'bohaif of.customer represents and warranle,that Ne/afie,has the uthort to bind c stouter,tttat the!or olegdasc 13 ns of wa t l andrriaterlals Fefruman88iselireteaapaekaged;`niarkediatidlatseted;are8y8yite'r'flans'p"ortatTonfn'aaaortiah'Re'wRh"'pplicabfe'aFtatoandtetlDial"r�guiHlians"snti`iiatou9=omershaiabido by the Stands r'a and conditions on the reverd'e'stda of this Service Order. Service 9tdors t ass hazardous waste manliest(either site speelflo or consolidated)are dub lsai to an EPA`peo. food cover the ERA passthrough fee and,administration of the eManifes he less vargbased on Mont eat typo. Appllcablo fees will appear on your b((Iling invoice. Customer S na r to Driver Signature Date en Print Name Print Driver Name �s