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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. N3773084 FOR ACCOUNTING CALL: ®'� 562-231-1550 VWORLD ENVIRONMENTAL SERVICES. 5 7300 CHEVRON WAY, DIXON,CA 95620 H IN N OUT BURGER 1-800-727-2879 IN N OUT BURGER-INN018 P 18240 S HARLAN ROAD 13502 HAMBURGER LANE P WWW.WORLDOILCORP.COM ° LATHROP, CA 95330 TRANSPORTER EPA#CAD028277036 BALDWIN PARK, CA 91706 T 0 (209) 858-8800 (209) 585-6800 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES INNtJIJZi TM I E= 124 rsan na d DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 10/21/2021 CAL00040220 D 2 2) 5 's 1 f lV� PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL WO USED OIL/MIXED OILS 22 SAT # TOTAL CASH RECD: CHECK# WASTE DISPOSAL INFORMATION �NOWRCRA NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUiMIXED OILS) STATE CODE 221 HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: XDESIGNATED TSDF: VVORLD OIL EWRONMENTAL SVCS-CERES 1920 MORGAN RD.CERES CA 95358 209 541-1825 CAL000393M ALTERNATE TSDF: Crass Streets: Amount Manager. Sam Read DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By s nfng below f hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) s")I have not mixed any of the waste dascribed above with any other hazardous waste,the total hafldo content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have - compiled whh the requirements of the applicable Caltfornia used all management regulations to determIne this Is true_I agras to accept the additional charges for the dlsposal of this waste If the Information t have provided about this waste to Incorrect 0 02 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,l have provided Proper documentation to World Oil Environmental Services to rebut tiro presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste If the Informatfen l have provided about this waste is Incorrect ❑03)This waste Is from a tank whlch collects waste oil from household"do4t-yourseir(utY)and/or conditionally exempt small quantity generator(CESOG)sources.TO the best of my knowledge,the only waste all contained in my DIY/CESOG collection tank Is soley from O!Y and/or CESW sources.I have not mixed this waste oil with any other h=rdaua waste or waste co from other sources.I agree to accept the additional chargee for disposal of this waste It 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 worsted 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 minlmb ms the present and future threat to human life and the environment. This individual atgning In the space sof forth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste and materials are true and"Carets as packaged,marked,and Labeled,are ready for transportation In accordance with appFlcabie state and federal regulations,and that customer shall abide by the Standard Terms and Canditlons an the reverse side of thin Service Order. Service 0 with an ass oe hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. fees cover the EPA pass-through fee and administratlon o!the anlfest program. taa9 very based on Wnlfest type. Applicable fans will aplteaf on your billing Invoice. Cu r natEJre Date Driver Signature Date Print ame Print Driver Name