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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (1/17) <br /> 1-800-7-ASBURYO SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> S 7300 CHEVRON WAY,DIXON CA 95620 <br /> H <br /> 1 1-800-7-ASBURY <br /> v <br /> p WWW.WORLDOILCORP.COM <br /> E <br /> 0 TRANSPORTER EPA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH REC'D:__ CHECK# _ <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOU5 WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTY DRUMS:___ FACILITY:_ BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby rerrify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Cls 1)1 have not mrrcd any of the waste dumbed above wish ary other haaarddi waste.the 1e1e1 halide content Is LES Than 1,000Igro,and the waste does rot conuin any PCBI.I have complied with the un uhements of <br /> the aPFOcableCatfornla used all management regulation to deemine the1s nue I ague m accept the ad;hII.1,ha vs Int the disposal of this wasteII(be Information(have providedabomthat wage Is Incorrect <br /> O121 have not mixed any of the waste dessit a d above with any other hazardous wam the total halide contend,GREATER than 1,000 ppmand the waste don nm comae aro PCBs.I <br /> have pwwded probe dncumaouuon to World Oil Erweonmental 5w.kes w rebut the W anu npdon that his wave was nixed with other harardnus waste.l ogee m accept the additional charges Iw the disposal of this <br /> wage If the Inhumation I have provided about this wage 1s Incorrect <br /> =131 Tht,wage b Imm a tants whkh sdiets wage dl ham housefwd'do-it-yoursed'IOM ardle<adlUungly exempt small gwmity geruvator ICESOGI sour<n.To the hest d my knowledge,the only wase ull mnulnm <br /> m rm W10ESQGco11wction lank Is soky I.atly nsfor CESOG sau cie,I bave ata mittd This waste all with any other haardom waste at wasieal from other sources l agree to xcept theaddltlowl charges for deposal <br /> d this wage Bthe Information 1 have provided about this waste n mcwret <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> ="I If I am a large quantity generator.I cemly that t have a program In place w reduce the.dume and wakiry of wage generated to the degree I have determined to be economically practicable and that I have <br /> selected the mxtkabl s method al veatmenl storage,or deposal aurally available to me whkh mW mean the present and future threat to human]Be and the environment Ob.if I am a small quantity gewrmar,I <br /> have made a good faith eadn to rmnsmm my,wage generation and sekcl the beg waste mabagersent method that Is h allade to me that I can afford. <br /> This individual ugnmg 1n the space set forth below on behalf of Customer retransmits and warrants that he/she has The authority in hind Customer that the forgoing deessimons of waste and materials are true and aacurau <br /> a pxmgatl,nvned antl bbalM,aro roadyfor rrmnpmtgion In arrnrdame wnh apnlicahk state arts IMeal regulatMns.arts that Cuname shall abltle and be bound by the StanMrd Terms antl Corrdi0om on the revere <br /> side o!mit Servke Order. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />