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FOR SERVICEIALL: 6 xnvl�c unucrs DIXON OFFICE ; ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-8 (1/17) 1-800-7-ASBURY SERVICE ORDER NO. FOR ACCOUNTING CALL: Gf, 0N202378 562431-1650 WORLD OIL ENVIRONMENTAL SERVICES% S 7300 CHEVRON WAY, DIXON CA 95620 " HOLT OF CALIFORNIA - STOCKTON 1-800-7-ASBURY P 1521 WEST CHARTER WAY WwW,WORLDOILCORP.COM P, 0. 130X X E T STOCKTON, CA 95206 TRANSPORTER EPA * CAD028277036 SACRAMENTO, CA 95813 0 (209) 993-5980 (209) 993-5980 CUSTOMER # PURCHASE ORDER It ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HAUDES HOL025 103 t>J $`� adavis DATE REQUIRED I DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA BILL of LADING/MANIFEST # 7/12/2017 CAL000827892 Q } 1H6C) v� t SSV PART # DESCRIPTION QTY UNIT PRICE CITYP/U TOTAL WO USED OIL / MIXED OILS wo $0,00 `Squ $0,00 III USED OIL SERVICE CHARGE 1 $65400 $88.00 MUST CNE :K TRUCK SHOP FOR WASTE OIL AND AF, ETC PER SCOTT HOGART 209 47 34952 BATC # Cro s Streets: TOTAL CASHREC'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: DESIGNATEDTSDF:prvnl2 I et p,.'Y'—OIX4nl rnacta_9,ang,�h)ltgtip0.i260^ ALTERNATETSDF: DRUMS P/l EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHEAPPROPRIATE CEI�,Eb Syslgning belowl herebycertifythab (Waste oil generator/customer MUST check ONE of the following th a boA14 1 8 2011 Ill have not mixed any of the waste desulbed above with any other hazardous waste,the total halldecontentis LEA than 1,000 ppm, and the waste does not rontx Zany PCBs.l have complied with the mqubei a tsar niallnble California used oil management regulations to determine this is true,l agree to accept the additional charges (or the disposal of this wash If the intens agrp}%provided about this waste is tmm� its ION2 l have not mlxed any of the waste desuibed above with any other hazardous waste, the total battle content is GREATER than 1,000 ppm, and thewaste doesnatconttaa177nIanypCgs. l •• " • ••' •• have provided proper documentation to Wald 011 Environmental Services to rebut the presumption that this waste was mlced with other hazardous Write.! agree to accept the additional charges for she disposal of this waste If the Infrnnation I have provided about this waste Is Incorrect Met)This wane is from a tankwhlch collecowasle ail from household'do-b-yourself"(DIY)and/or conditionally roenrpt null quantitygenemim (CESCIG1 seurces.To the best of my knowledge, rho only waste bit retrained joint Gly/ CESCIGcnllectlon tankis soleyfrom DlYand/ar CESOGsources. l have not mixed this waste oil wall am other hosardous waste or Waite Oil ham ether saunas. ! agtee to acconthe additional chandos for dispowi of this waste If the Information I have provided about this waste Is Incorrect (All generators/ customers MUST read the following text and check the associated box.) IA) Il i off) al etgequantltygermmtor, lcettlly that l have a program In place wroduce the volume and toxicity of waste generated to the degree l invedatermined to beeconomiwllypranicalde and that l have ulectad theswacllrnhlemethod of ueatm int. storage, or dispmal currently available tome which mmnloes the present and futurethr ize as human life and the everairmenbOr, if I am a small quantity generator, I ]save made a good faith effort to ndrdnvze my waste generation and :elect the hescwaste management owning feat is and able to me that l an afford. This that hvigne tile huthonly to nd em; of wage and rates 5 am raw as packaged, marked gedan thaspxc setfoods belowon nationlf in ac`ordanomer cesresents with applicable stare and federal regsLdnns, and put Customer shall abide anforgoing d be bound by thle Standard Terms and Condizonuon the v%zoo side oFagedrviceO er. luheleJ. arc wady mrunspor side of this Service pda. �7 I.13 / 1 Customer Signature Date Driver Signature Date L6stJ Print Name Print Drivers Name