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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8(18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER N0. <br /> FOR ACCOUNTING CALL: N3634814 <br /> 562-231-1550 WORLD OIL <br /> ENVIRONMENTAL SERVICESw <br /> 8 7 00 CHEVRON WAY,DIXON,CA 95620 <br /> 1 STOCKTON SCAVENGERS ASSOCIATIONS 1.800-727-2679 WM OF SACRAMENTO NEVADA AF <br /> P 1240 NAVY DR WWW,WORLDOILCORRCOM PO BOX 4745 <br /> D <br /> MONTHLY WO TRANSPORTER EPA#CAD028277036 <br /> T STOCKTON,CA 95206 PORTLAND, OR 97208 <br /> o (209)460- 912 (916) 294-4035 <br /> CUSTOMER# PURCHASE ORDER# I ROUTE#I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ST0621 10110807 ROUTE 12 p W( ANGELICAMAGANA SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFE <br /> 612212021 6/16/2021 CAD980737225 021 526 /51,? J71(L <br /> PART# DESCRIPTION QTY UNiT PRICE QTY P/U TOTAL <br /> PFODI USED OiL f MIXED OILS-DIY 130 <br /> f p� <br /> ONLY RG OIL P/U&HAZ plu -USE USA605 FOR DIYTANK ANJELICA 209 460 3925 ,EQUESTOR: SMEDINA4@WlV,COM <br /> /USE P 10110807-2 FOR VAC BATCH# TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OiUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: ASBURY ENVIRONMENTAL SeVF�ICES CEf2E5 192tl ILi4RGAN Rp. CEF:ES.CA 9x359(209}541- 6 5 CAL000303680 <br /> ALTERNATE TSDF: <br /> GassStree#s: PIU REG OIl. -1A PiU REC�UESTOR_,4Pl —Q-1NA4aWM.COM Account Mansger:Sam Read <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certlfy that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ❑711)1 have notmixed any of the waslc described nbovo with any other hazardous waste,the total halide content Is LESS than 1,090 ppm,and the waste da:•s not contain any PCB9.I have <br /> eomplted',vlth the racluitemersts of theaRpllcable Calilamle used all management regulallons to doterm[ne this true.Ing reeto accept the addittonaI charges for thedl;pasal of thiswasto If <br /> The information I have provided about this waste is Incorrect <br /> ❑#21 have not mixed any of the waste deserlbed above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,end the waste does not contain any PCBs.I <br /> have provided proper dacumoniailon in World oil Environmental Services to rebut the presumption that this waste was mlxed Mill other hazardous waste.I agrna to accept the additional <br /> ,c�hharges for the disposal of this wast•=if the Intonnailon I have praVldCd about this waste Is incorrect <br /> 't 03)This waste Is from a tank which colkeL wade oil from ho us cha Id"de-11-yo urs oil"(1:1[y)and/or condi Ila nn]IV exempt small qe ard[ty generator[G ESO G=Sources.To the bast of my <br /> Irnov+[edge,the only was'.o on contained In my DIYI CESOG colIt,clion Sank Is so ley fro m DIY and/or CESOG sources.i have not mixed this waste all with any other baZUrdous waslo or wasto oil <br /> lrom other source;_I agree[a accept the addlt tonal cirargcs for dispesnl of Ihls wa die if We info rma don I have provided about this was[o Is Ili"rrcet <br /> (All generators/customers MUST read the following text <br /> I certify that)have a program in place to reduce I h a volume and tax lclty of waato generated to the degree I have daterml ned to he eco nurn I c asly pra c[Icable and Ilial I hava selc clod 11-e <br /> practicable method of treatment,storage,or disposal currently oval IabIa to me which minlmlzea the present and futuro threat to human Ilia and Iha environment. <br /> Thi;I n d lvid un l sl g nl n g in the n pace s et to riff below on Lshalt of cualome r repres ants an d w arran is that h a/she has th e a uthority to bind Gusto m at,t In at t he to rg at ng do ncr iptlon9 of was to <br /> and nlalortalc are t rue nn d acvu rale as packaged,marked and labeled,are ready for Iran n p urlal to n In asco rdan ca with 9ppllcnbie stale and todaroi to g ul alto a a,and th a t e ustomer sh an abide <br /> by the Standard Torms and CondlitDns on the rovers sl do of this Service Order. <br /> Snrv[caOrderswith anassoc latod hazardous waste ran nl[c,:l(eitharslie spactflc or canaolldaInd)are subject[o an EPA Fee.The^es covartha EPA pass-through fee and administration <br /> of the oWan fcsiprogram.These fees vary based on Manlfest type.Applicable fees will sppcarcn your billing Involce. <br /> DCustomer Signature Date river Signature Date <br /> Print Name Print Driver Name <br />