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ERVICE CALL : SERVICE CRDFR FORM NO. WOES004- B (8/181 OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA I , > ' 727w2879 SERVICE ORDER NO . CCOUNTING CALL: 1 - 1550 m + WORLD0 ,1L ENVIRONMENTAL SERVICES, 7300 CHEVRON WAY, DIXON , CA 95620 1 -800-727-2879 •.t�;i i � :.lS �'�.� '`: `s z` �P'' � �.f'i'v� . ��tl � � :..:.1- �4. t F`=. __ WWW.WORLDOILCORP . COM TRANSPORTER EPA # CAD028277036 :' z s. . ''-`4 . _ :� � .�-..iii: "+�r� ;� � ��.... �;,k. ,•z' ��_; OMER #. PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES EOUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # r # - DESCRIPTION QTY UNIT PRICE QTY P/Irl TOTAL •'.; � .9 t-- '� ti� L:,7 °`� .t`.� ti st... L� F �. { t t � �; L'if6. y. lk 13 :1 0 - n m F iSTCW t.. t E. 04. iS:H TOTAL w RECD : CHECK # 3 WASTE DISPOSAL INFORMATION y )N-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 �JN-RCRA HAZARDOUS WASTE, LIQUID ( ETHYLENE GLYCOL SOLUTIONS) STATE CODE N rHER : r4ftLM_ PC-.R 6 o4 A APQ41i MO � a .F ZT!:r 02 M2 tp. , _SIGNATED TSDF: d3 . is *S . V �f € P 4x�i� ; - , ^ f � g u ;, ; j < �: _ :.a } � � S$ C�$ a_oT ti3kl. 1`1RUL .d . . t� ia _ i di;i ^ s C,v :tei.l. . i aid . .�_-.ar-.SFW_ C311_< £'. fr- _TERNATE TSDF: 4 ??:GuVk �;? a. ,� 3 P/U : EMPTY DRUMS : FACILITY: BSC t _ GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) tg bcttow I hereby certify that: (Waste oil generator/custorner MUST check ONE of the fol oWing "three boxes ) :ave 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 - i 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 oration I have provided about this waste is incorrect ave 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 vided 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 for the disposal of this waste if the information 1 have provided about this waste is incorrect . . W tis waste is from a tank which collects waste oil from household "do-it-yourself (DIY) and/or conditionally exempt small quantity, generator (CESQG) sources. To the best of my ge, the only waste oil contained in my DIY/ CESQG collection tank is soley from DIY and/or CESQG sources. l have not mixed this waste oil with any other hazardous waste or waste oil er 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/ custorners MUST , read the following text hat I 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 1 have selected the 11e method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment _ vidual signing in the space set forth below on behalf of customer represents and warmms that he/she has ttte authority to bind customer, that the forgoing descriptions of waste >rials 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 andard Terms and Conditions on the reverse side of this Service Order, lyders with an astsociated hazardous waste manifest (either site specific or consolidated) are subject to an EPA Fee. -These fees cover the EPA pass-through fee and administration Manifest p ogratn_ These fees vary based on Manifest type. Appiicable fees will appear on your billing invoice. mbr Sfature Date -Driuei,,Signature Date A ' fi4 4arne Print Driver Name