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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: d3a75�99 562-231-1550 Ck WORLD OIL ENVIRONMENTAL SERVICES- H STOCKTON SCAVENGERS ASSOCIATON73oo CHEVRON WAY,DIXON,CA 95620 WV OF S CRAVSN—O NEVADA ARE P '1240 NAVA'DR 1-800 727-2879 PO COX 4745 P WWW.WORLDOILCORP.COM E MONTHLY WO s rOCKTON, CA 95206 TRANSPORTER EPA#CAD028277036 PORTLAND, OR 97208 T (209) 460-3912 '916) 2,94-4035 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ,910527— amedina4 wm.eom 7n'7i� 1 OD GANA arias er DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 4/2712022 CAD980737225 0-0Z 1h) ►(-i 7J 1 k PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL PF PAPER FILTERS PER DRUM 1 1 OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE 1 ONLY REq OIL PN&HAZ p/u -USE USA605 FOR DIY TANK ANJELICA 209 460 3925 R 0.1.1E.4'TOR:A GELICA MAGA AME71. i,§WM.COM!@LANKET PO 2021 /0534249 BATCH# TOTAL CASH REC'D: CHECK#_- WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE L. OTHER: _bf0N.RCRa HAZAln,� :Ic lNacrr= crit rn rnll Y onRi-FU121 da'r't_ II Tr--RS I fIr- IS, DESIGNATED TSDF: YF_ M$�ENT_ING.&500 US Fff Y 95,YIJhdA_^Az 95365 _. ALTERNATE TSDF: nil _ �1A7 Dfi 1 �=QLJES1QR- AIIfEDINA.4dWM G0M Al:eount Uariatter Samuel Fuad DRUMS P EMPTY DRUMS: _ FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) LJ#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 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 the information I have provided about this waste is incorrect J#2 1 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 have provided proper documentation to World oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste 11 the information I have provided about this waste Is Incorrect ❑#3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt smell quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained in my DIV/CESOG collection tank Is soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil 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 (All generators/customers MUST read the following text 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 practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. This individual signing in she space set lorth below on behalf of customer represents and warrants that helshe rias she autharlty la b d customer,that the forgoing descriptions of waste and malerlafs are true and accutale as packaged,marked,and labeled,aro ready for transportation in accordance with applicable and federal regulations,and that customer shall abide by the.Standard Terms and Condifions on the reverse side of this Service Order. Sa ❑r rs with an associated hazardou asie manifest(either sitespecific or consolldaled)are subject to an EPA Fee.Those cover the EPA pass- 9b fee and administration of he aMan'est progrramThese fees v ed on Manilleest type. Appilcabie fees will appear on your billing invoice. u 7�% If *Printame ignature a e r er Signature Date elm=Print Driver NAne