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RECEIVED BY SJCEHD (EF) on 4/3/2020 SERVICE ORDER FOR SERVICE GALL: FORM NO.INOESD04_g (1 /17) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DSA 1-900-7-ASBURY WO rW. SERVICE ORDER NO. FOR ACCOUNTING CALL WODIY N2338508 562-231--1550 AF WORLDOIL ENVIRONMENTAL SERVICES, H' PEP BOYS #0711 7300 CHEVRON WAY, DIXON CA 95620 THE EC GROUP P 49$71111EST LANE 1-800-7-ASBURY 201 F, ORCHARD ST P WWKWORLDOILCORRCO€A D STOCKTON,CA 95210 TRANSPORTER EPA t CAD028277036 HAMMONTON, NJ 08037 o (209) 952-1222 (800) 334-3794 CUSTOMER # PURCHASE ORDER II ROUTE # TRUCKA. CONTACT NAIv1E ORDER TAKEN BY HALIDES PEP359 124 CHEDULED-I DATE REQUIRED BATE ENTERED NEKT SERl11 DATE CUSTOMER EPA fi BILL of l_ADINGIMANIFEST k 3/21/2017 3/21/2017 CAD981662844 � � 77 PART DESCRIPTION QTY UNITPRICE QTYP/U TOTAL WOSC USED OIL SERVICE CHARGE 1 Wo USED OIL / MIXED OILS BATCH # CraS streets: TOTAL CASH RECD; CHECK # WASTE DISPOSAL INFORMATION X NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIOUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF:--ASg�EI 4f ME"'t n=. _ ��et t�rn,Y__r„ Ear, cn�e�e raq H 5$ ��9 -1r-", ALW933M6$Q ALTERNATETSDF: DRUMS P/U: EMPTY DRUMS: _ FACILITY; BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) ey sign;no befowfhereby ceriifythat: (Waste oil generator/customer MUST check ONE of the following three boxes) I.1) I have Mat 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 € Cds. I have complied vdth the requirements of r t e nppkiible California used oil management regulations to determine this is ttue.l agree to accept the additional charges for the disposal of thiswasle If the infnrf cation I have provided about tltil wasta is incorrect C7-'? I have not mixed any of the waste described above vAth any other hazardous vraste, the total halide content is GREATER than i pati ppm, and the waste does not contain any °C& I have provided proper documentation to World Oil Fnvkonmental Servlres to rebut the pfest+mphon that this waste was mixed with other hazardous waste, l agree to acepr the additional charges far the disposak of this waste if the htformation I have provided abaut this waste Is incorrect =43M, vraste is from a tank which r oliecis waste oil from hausehofd "do-if-yovrself"{DIY{ and/or conditionally exempt small quantity generator fCFSQG) sowces. To the hest of my knowtedue, the only waste oil contained in my DIl'(CESQG collection tanl; is soley from DIY and/or CESQG suwces. i have not mixed this waste oil with any other hazardous waste or waste oil from other sources. I agree to accept Ike additional charges for disposal of this waste if the information I have provided about tills svaste is incorrect k1R-1�---- (All generators/ customers MUST read the following text and check the associated fox,) if I am a [atge quantity gen'_rator, I certify thatI have a program In place to reduce the volume and toxicityof waste generated to the degfee I have determined toho economicallypracticable and that i have led the prachcahte method o€ Ifeatment, storage, of 0sposat currently available to me which m1nimixes the present and Suturethreat to human life and the Environment: Or, is 1 ant a small quantity generator, i made a good faith effort to minimize my waslegeneratlon and select the best waste management method that is available to me that I can afford. This Individual signing in the space set -forth belay on behalf of Customer represents and warrants that he/she has the authority to bind Customer, Thar the f roomy descriptions of waste and materials are true and accurate as packaged, marked and Iabelec, are ready for transportation In accordancesvkh applicable state and federal regulations, and that Custamer shall abide and'oe bound by the Standard Terms and Conditions an she reverse Sid e of ys S/�y'vke Order. Date Drivel Signature , Date Gusto r Signature j�%