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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8 DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 I . FOR ACCOUNTING CALL. WORLD O I L 562-231-1550 If� Fl ENVIRONMENTAL SERVICES F1 g 7301] CHI WAY. DIXON,CA 95620 b� Iw N caul Iuf sa�:�-: IN N OUT hu i 1-ati3O-727-2e79 • p HARLAN ROAD t i HAIAL WWW.WORLDOILCORP.COM E I HH A TRANSPORTER EPA#CADD28277036 i T FIALaWIN'Fr°,+kK. 00' o i J)iiSfS f (2W) t3`i t, llO CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDE f DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# `kuf a 1r1J6a _.'iLUUU-1--J. PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAI Lin r .5 GALLON On'DRUM (RI UNDI'1'1ONFI]) IrMA[4IFFI=S'r LPA ADMIN - SITE MANIH 199 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. OTHER: DESIGNATED TSDF• r TRiAW.&F:R STATION,frtiW SOUT"`iS H QHWAY 96,YUry *y 863rc- ALTERNATE TSDF: DRUMS PIU:__-. 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) ❑41)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 ( compiled 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 U 421 have not mixed any of the waste described above with any other hazardous waste,the total ha-ide content Is GREATER than 1.000 ppm and the waste does not contain any PCBs.71 j have provided proper documentation to World 011 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 it the Information I have provided about this waste Is Incorrect 0#3)This waste Is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my ON/CESOG collection tank Is Soley from DIY and/or CESOG sources.I have not mixed this waste ol:with any other hazardous waste or waste o 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 generated to the degree I have determined to be economically praeticabie 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. y Th Is individual signing In the apace set forth below on behalf of customer represents and warrants that hefshe hes the authority to bind customer that the largoing descriptions of waste and materials are true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations.end that customer shall abide by the Standard Terms and Conditions on the reverse side of this Service Order, Service Orders with an associated hazardous waste manifest(either site specific or consolidatedi are subject to an EPA Fee These lees cover the EPA pass-through tee and administration .(the eManlfest program These lees vary based on Manifest type. Applicable fees will appear on your billing invoice. Customer Signature Date 1---Drlver Signature Date " Print blame -Print Driver Name