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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8118) <br /> DIXON OFFICE ASBURY ,ENVIRONMENTAL SERVICES, DBA <br /> SERVICE ORDER NO. <br /> 1 =801: 727-2879 - <br /> WFIF- ACCOUNTING CALL: WORLD OIL <br /> -231 -1550 . <br /> : FF ENVIR0 <br /> ONMENTAL SERVICESTM <br /> Jx DISCOUNT I.I F$ - LaU18Ir AVE: CHEVRON WAY , D1XbN, CX95620 <br /> 1 -$0C 727-2879 . <br /> P 367 W LOUISE AVE 367 W4 LOUISE AVE <br /> WWW.WORLDOILCORP.COM - <br /> TRANSPORTER EPA # CAD028277036 <br /> MANTECA , Cly, 995336 MANTECA ; CA x5336 <br /> o (209) 825-1910 d. ` 2091 825 1994 <br /> CUSTOMER # PURCHASE ORDER # " ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> %JjLjuu i i 100772`iz, 7L=j tKiUA vDernai S <br /> DATtREQUIRED DATE•.ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST If <br /> 613012020 CAL000357760 <br /> EIC <br /> PART # ESCRID PTION QTY UNIT PRICE QTY P/U TOTAL <br /> IIIIIP> VVU U51= L . tY1fXf=U UILS . bt) $U,%UU <br /> 11 OSCUSED OIL SERVICE CHARGE f $ 215. 0C 215. O0 <br /> M 9F PAOED DRIVE <br /> TOTAL. <br /> CASH REC.'D: CHECK # <br /> WASTE DISPOSAL INFORMATION - <br /> NOWRCRA HAZARDOUS WASM LIQUID (USED OIUMIXED OILS) STATE CODE 221 I <br /> NON-RCRA HAZA - - - - -- •E GLYCOL SOLUTIONS) STATE CODE fir_ <br /> DESIGNATED TS[ ACES t:eRES, 4920 MORGAN RD . , CERES, CA 95358 (208} *4di =1x25, CAL01703'33�C � <br /> :ALTERNATE TSD f <br /> Crf� Street � V1 �(� (f � Wil S A=aunt i+�anager Sam Read <br /> iOPUMS P1) : r lah V FaC1uTv0 _ BSC <br /> ICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> 6'a,' sWiing below 1 hereby cwt y <br /> (Waste oil generator/customer MUST check ONE of the -following three boxes) <br /> &B1} 1 have not rvifted any of the waste described above with, any other hazardous waste, the total halide content Is LESS than 1 ,0.00 ppm, and the waste dose not contain any PCBs. i haws <br /> compiled WMI the rawramerts of the app[xsb:a Caf&nir a usad all management regi:laflens !c 3etetmine this Is true. l agree to accept the addMoFraai chgrges for the disposal of this cast 9 <br /> Me bttornation Lbrev provided about this waste Is Incorrect <br /> In 4 hsrvc not mixed arty o( the waste described above with any other hazardous waltz; th a rotal halide contends GftEATERtharr 1,000 ppmt, and the waste docs not cArRain am' r l ass. i <br /> i a„F provided proper Eoeumentallon to Work! Oil EnvironnoMal Services to retort the presumptlon that this waste was mixed with other hazardous waste. t agruo to accept Or, addlVanel <br /> - h:ircjes for the disposal of this wasts It the Mdormidlon I have provided about this waste is incorrect <br /> IF <br /> FF <br /> ❑ t 3) this wQsts Ne Neem a tank which oWliecta siaata all from household `do-it-yourself" (DI`) and/or ernattion:tly ex mpt small quatllSy gww rotor (CEOW soaroas. To the hest of " <br /> knowledge, the only waste ort contained In my DIPJ CES00 collection tank Is sofey from DiY-andlpr CESOa sotieeas. 'I have not mbtsd ff" waste oil wish any otter hazardous waste or waste oil <br /> Rom otlw souroese t a" to accept the additional charges for disposal of this waste If the Informatlon i have provided about this Waetaie Ineorreel <br /> (AIL generatorsl. customers MUST react the following. text <br /> t certtry that 1 have a program In place to reduce the volume arta toxicity of waste generated to the degree 1 have dawrithbd to be eoarornically predicable and that I hcvs solocte.; the <br /> Rirect'_uable method of traatmen4 storage, or disposal currently available to me which minimizes the present and future flares! to Neaman Us and to environment. <br /> 7h his trod:vIdual stlpiing In-the apace act forth bakm an behalf of.eustomer represents and watmrtts that hdatw hes the authority to bind eustonw, that the forgolirr�� descriptions of masts <br /> acrd materials ars trurend-acc rsts as pscfaigsd, markro re <br /> ed, and labeled; am for transpiortation In accordance with applicable stab and federal regulations and that customer shalt abide <br /> by the Standard Terme and Conditions an the reverse skis of this 3etvice Order. ' <br /> f stales Orders WMh en easooleted harardous weeee aamrttest (ettloer site spedfk or consoudated).are sub��aeedt m an EPA Fee. Nein cover the EPA passthrough fee and administration <br /> of the elNendeat program.. These fees vary based on IilmlFast type. Applicable hes will appear on your bi7ilbng Invoiat <br /> 7 / <br /> Gust=. or Signature Driver i Date <br /> Print Name` <br />