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IMPERIAL TRUCK WASH <br />2142W. YOSEMITE AVE <br />'MANTECA, CA 95337 <br />(209) 239-8111 0-i C.)111 -0 -U ^ :I: (f) FORM NO. WOES004-B (8/18) <br />1 <br />1 SERVICE ORDER NO. <br />IMPERIAL TRUCK WASH AND REF-7 <br />2142 W YOSEMITE AVE <br />MANTECA, CA 95387 <br />(209) 239-8111 <br />N4088673 <br />rivetr-4nature Date <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES, OBA <br />WORLD OIL <br />ENVIRONMENTAL SERVICES,, <br />7300 CHEVRON WAY, DIXON, CA 95620 <br />AND REPAIR JAZZ I -800-727-2879 <br />WVAILINORLE,IOILICORP.COM <br />TRANSPORTER EPA 4 CAD028277036 <br />I • <br />FOR ZERVICE CALL: <br />DIXON OFFICE <br />1-800-727-2879 <br />FOR ACCOUNTING CALL: <br />562-231-1550 <br />I CUSTOMER * I PURCHASE ORDER 4' ROUTE # 1 TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br />[ IMP072 I CER-86 MANJET SINGH .aroOriouez <br />'DATE REQUIRED 1 DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # <br />4 <br />1 <br />9/15/2022 CAL000368693 t <br />1 <br />! <br />PART 4I DESCRIPTION 1 QTY . UNIT PRICE QTY P/U . TOTAL <br />TRA 1 TRANSPORTATION <br />TRKW TRUCK WASHOUT <br />VACULII VACUUM DISPOSAL- NON <br />i <br />1 • <br />;BATcM#TOTAL <br />-HAZARDOUS WASTE LIQUIDS <br />1 <br />i <br />4 <br />1 1200 <br />$125.00 <br />$105.00 <br />$0.25 W <br />$125.00 <br />$420.00 <br />$1 140.00 <br />„ <br />6( LW/Dd. <br />Dde <br />CASH REC'D: CHECK <br /> <br />WASTE DISPOSAL INFORMATION <br />!r--1 NON-RCRA HAZARDOUS WASTE, LIQUID (USED OiLliVIIXED OILS) <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br />I OTHER: <br />DESIGNATED TSDF: <br />ALTERNATE TSDF: <br />IL Cross Streets: OLD ACCT IMP067 <br />1 DRUMS P/U: EMPTY DRUMS: <br />STATE CODE 221 <br />STATE CODE <br />Account Manager: Samuel Read <br />FACILITY: BSC <br />GENERATOR WASTE CERTIFiCATiON (PLEASE CHECK THE APPROPRIATE BOX) <br />By signing below I hereby certify that: <br />(Waste oil generator/customer MUST check ONE of the following three boxes) <br />-•1) i have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than 1,080 porn, and the waste does not contain any PCBs. 1 have <br />complied with the requirements e 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 />tile information I 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. <br />have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. 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 />Ii #2.) This waste is from a tank which collects waste oi: from household do-it-yourself' (91V) and/or conditionally exempt email quantity generator (GEMS) sources. To the best of my <br />knowiadge, the ority v.,asta oil contained M my Cm CESCIG collection tank is soleyftortipiy:andior CESOG sources. i have not mixed this vraste oil with any other hazardous waste or waste oil <br />front other sources. I agree to accept the additional charges for disposal of this wastegthe information I have provided about this waste is incorrect <br />(Ali generators/ customers MUST read the fo)lowingaxt <br />I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econcrnicar41,0ia,..-ti'S cable and that I have selected the <br />practicable method of treatment, storage, or disposal currently available to -a ',V )1 Ch minimizes the .present and future threat th human iife an4e.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 Conditions on the reverse side of this Service Order. <br />Service Orders with art associated hazardous waste manifest (either site specific or consolidated) are subject to an EPA Fee. These fees cover the EPA pass-t ough fee and administration <br />of the eManifest program. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br />-Nee; tomer Signature <br />-