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4 <br /> FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br />{ DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBASERVICEE ORDE <br /> ORDE <br /> 1-800-727-2879 <br /> C FOR ACCOUNTING CALL: AMLWORLD OIL 562-231-1550 <br />! ENVIRONMENTAL SERVICESr <br /> S 7300 CHEVRON WAY,DIXON,CA,95620 <br /> I FIRESTONE#028746 1-soo 727-2e7s QUEST RESOURCE MGT- FIREST( <br /> P 720 E. HAMMER LANE WWW.WOFJLDOILCORP.COM 3481 PLANO PARKWAY. <br /> D TRANSPORTER EPA#CAD028277036 <br /> o STOCKTON, CA 95210 THE COLONY,TX 77056 <br /> (209) 951-2403 (972) 464-0004 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> FIR627 1021513 CER-86 <br /> ZA WILLIE GLADNEY iahemandez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 11/29/2021 CAL000366211 02- 3;5.6 gQ o J J <br /> PART# DESCRIPTION CITY UNIT PRICE OTY P/U TOTAL <br /> .,,OFDR. OIL FILTER DRUM.REPLACEMENT- NO CHARGE 1 <br /> OFNC NON CONFORMING,USED'OIL FILTERS 1 Z, <br /> BAT # <br /> TOTAL <br /> CASH REC'D: 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 /> XHAZARDOUS WASTE,SOLID(1-ILTERS CONTAINING 01t) brace Code"3 <br /> DESIGNATED *E6MANAGE y}EP1T-INC.,6500 US 1119HWA*955,Y "r MA,AZ 85365 <br /> ALTERNATE TSDF: <br /> riA.anigs-ml;Manager, Sam Rej <br /> a <br /> DRUMSPIU EMPTY DRUMS; FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below 1 hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ❑#1)1 have 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 PCBs.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true.i agree to accept the additional charges for the disposal of this waste if <br /> the information 1 have provided about this 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 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.l 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 /> ❑#3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESGG collection tank is soley from DIY and/or CESGG 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 I 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 minimizes the present and future threat to human life and the environment. <br /> This individual signing 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 <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations,and that customer shall abide <br /> by the Standard Terms and Cobditions on the reverse side of this Service Order. <br /> Service OcOers with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees co ar the EPA pass-through fee and administration <br /> of the eynll!sPprogram. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br /> Customer Signature Date DrSignature Date <br /> ' a <br /> fgt l-v,7%-v. .l Q zJDA "1' -- <br /> Print Name Print Driver Name <br />