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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-8 (1117) <br /> 1-800-7-ASBURY O 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-A5BURY <br /> P <br /> p WWW.WORLDOILCORP.COM <br /> E <br /> D <br /> 1 TRANSPORTER EPA p CAD028277036 <br /> 0 <br /> CUSTOMER ff PURCHASE ORDER N ROUTE N TRUCK g CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA p BILL of LADINCIMANIFEST p <br /> PART N DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK 1 <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WA5TE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: _ <br /> DESIGNATEDTSDF: <br /> ALTERNATE TSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br /> Sy signing below I hereby certify Ihac <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Oall 1 have,not mists any a our wale devribei above wish any other haardaru waste,the total haute consent is LESS than I=Wis.and the waste does riot contain any Iii have complied wish therequhemmp of <br /> the applkabie California used oil marugemen regulations to daterni ethis Is true,I agree to accept me additional charyes for Ne disposal of this wastt it the information I have provided about this warts,Is incorrect <br /> Oa]I have not mixed any of the waste described above with any other retarders waste,the total halide content Is GIIEATH than 1.0110 ppm,and the wave di not contain arty Kos.I <br /> have provided proper,Eocumummmn to World Oil Frxmmrmeental Services to rebut the presumption that this waste was mixed with ober hmarchus waste I agree in accept Ne additional charges for the disposal of this <br /> waste If me inf motion I have merriest anent this waste is incorrect <br /> O831 This waver nom a w which collects wave og From household"aa syoursal101Y1and/or conditionally eumpt small quanthy generator(CESDGI sources.To the best of my knpwletlge,the only waste all conteuxd <br /> M my DIY/CE50G collection tank is roue,from Dry andlos CESW source,.I hove not mixed this warte ell with any ocher hoarineus waste or waste 0 from other source,.I agree to accept the addltiorel charges for dHpmel <br /> of this waste If the information I have provided about this waste Is Inaorrevt <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> Otal Ii I am a larye Vuanuty gerwsator.I mpiy that I haw a program In place la reduce the velums,arts soapy of waste gerre.ated to Iha degree I hew detaamirwd m ha ecarwnxcally pracucabb and than I have <br /> bel"mathe practicable method ittmarmem, ageg.ordisposal currentlyae bmI wase whichmentm the present andfawnsthreatI rumen Ids,arts the envlronmenc Or,itlamasmallquanlhy gerrerasor.l <br /> have made a goedhnh Mon to minlmbe my waste gerhmrion and select the font wane martdgerrhem method that 15 available to rite that I can afford. <br /> this Individual signing in the space tat forth be.on behalf of Crs1OmM represents and warrants that Wow has the authority to bind Cuslonserthat the forgoing dauriptions of waste and materials are true and accurate <br /> as ya,ke,M maM1M and labeled,are ready fm raeusmo nnn In arforMnre with applicable sate and federal m,ubttons,asW that Customer shall aside and be bound by rhe Standard Turns and Conditions on the reverse <br /> side of this Servlw Order. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />