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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICI~ ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOGS004-8 (a/18) 1-800-727-2879 SERVICE ORDER NO, FOR ACCOUNTING CALL: R LD O I L �131 r1fi t to ENVIRONMENTAL SERVICES, s i;1q 11-V RON WAY.aa X ON,CA 95620 " JIFFY LIJEsE> ~ t r2 a�7 RROAMAS€ INC • FA,7.Ag P E I{I+TtL klAia RD WWW.WORLDOILCOF[P.COM 1471 SHORF STREET U MONTHLY IRILLING 40 $0- TRANSPORTER EPA+r CA13028277036 T LOU3. CA 95240 WEST SACRANIF N 1'0 CA 90-, j t {= 1 ', 14)'1$137!-17c5 CUSTOME=R N PURCHASE ORDER At ROUTE 0 TRUCK 0 CONTACT NAME ORDER TAKEN BY HAUDES DATE REQUIRED ELATE ENTERED NEXT SERVICE DATE CUSTOMER EPA d BILL&LADIN1WMANIFEST it PART# DESCRIPTION QTY UNIT PRICE QTY PJU TOTAL USED MPTAL GlL ,l G GASOLII E FIL l ERS f OIL FILTER DRUM RE-PLACEMENT- NO CHARGE TOTAL SH REC'D: CHECK # WASTE DISPOSAL INFORMATION 1+ON-RCRA HAZARDOUS WASTE, LIQUID tLISED OIUMIXED OILS) STATE CODE 221 NOIR-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SQLUT1ONS) STATE CODE OTHER:, - -- - - �nIR- DESIGNATED TSDF: AM;lIr _v- ALTERNATE TSDF, LJ OHUMS PIU; EMPTY DRUMS: FACILITY; BSC- GENERATOR WASTE CERTIFICATrON (PLEASE CHECK THE APPROPRIATE BOX) By slgtmeny brlaigr 1 ht abw Cwwv tfW- ' (Waste oil ge nera tor/cu slome r MUST check ONE of the fallowing three boxes) Iii i hdvb nol mixed any of the wnsiet de=libed repave wOh any othvt ha arMDus waste,the Wal hphdie ront&nl Ip LESS than 1,1000 ppm,and the walla does Rat i CMERIn any RCBI hast aornplled wilt[thin ftSQYdT41Mnt}CT rhrraPpdieable Lagrorrus uaauoi menagr"l-c-t M-UulN150-ne la Ovtarn-uw Itil!as[run.I sgrao to dtcaV the adtiinoralt ehnrgco for mo cusposal or Lan-08811 U.kil4rttFltt4d t have pravddind above iWit waslr is Inrarraet 0 an 1 Ra4e nat mlxw any of illi waata rl r rl Bed above wm a"ether harAzacmd Waste.ilio tore+t1MPdrt C011141011 In 611EATER marl 1,0010 ppM A110 the waste Cava not crrnWn arty PC 90.1 Imave¢rOY10M prnPet d0CVnMniALI"10 WW-d Oil Earv]rannrt>nlet 50MCe&go retwY Im prt;umpeon that Ihla wasle was Iniwf rah new 1 o¢Tee w accept cm ada:dand act,apppo fat the disposal vt th!:wrtce it the:niarrrLvn n t naMe pmutdod atrimul Ihls wal to:a incorrect s7}Thle bast+Id fratm a I.V&wfNeh caNecte weal*oil fit"h&-i6,mQrd'da-It-Itxtrao1-IDIY)arinrar cAwWWcnsny r..mpi wraal quarmdy gerignI IUSBG}vourc—Tome bear o-f mY btoq ma¢�d,aw an1y-into tw"m m4 in tmy ptw/C�SOG coli iaw tank is so1Cw frotnVY and'ar CES06 aourtos.I have rloe Mlxlda trill MMEW 01f w11h any vtnat MKNdoua westo-Dr waata 1341 ffptn fATrrr aowco-i agrw to li=- 'thr ddiM[nal Ci't1rgwas for drsposed cif-thin rrasde Il the Inrormori n i hays Ph;-wided ahpur two rr" Fe 1rKvrracH (AII generators/customers MUST read the following text I Cartrrl thal I friM'Q a pragrvm in pl*x t4 re 1ye0 the vol u and 153rtc�Iy of wa rn generaird to an dugrrft 1 Nva 60te-T ,10 lsr he acz-0rnFrJdY pr odic*fb and thol l nrre aaiscied IN pi-WIC F1tlr n wthod of Irae4rrent,akvn{l*-as dlaposal curtdnl[V oviolablr lo me wrtrCh mIri"I;os R-e 0,v*enI and tulura Ihrnad w hun-an uta andlhr nrvtrcrrraw-t. { T71I0 Irtdlvld-ral algrminq In the apace lel Forth b lkrw on.WWI of ratstnlirw represents and reframe rnat-4wshc nes iris aulltwill tp bLrod cushrww tree'/r f4+1'Odrill4hscrlpgans of elate wad lttaYsrlada M4[fere fond aecwirm as fwckwnd,m fted.wA 10600,ur toady Iris IrMUMORMIA In We"WI-rar-cr with applFGs4ia atatt and tadm'al r0gtdatlimw■nd dote apnlomar Moll atrddd .it�ltFr twtl8rd Tarteta7RFd't.4tt7llwna am VIA flywr"1HWQO Iftl■Sddvlcrs Ortlff, 'Y U►v 4 c,a Orden wkh w anattdrFad weir•-rlonHral t#It:rw elle apaclnc pr ennsdldelyd)err pipet m r E Pa Fir Thmo fere rnrcit Lho EFA pzi&1 Llgh Iw■n6 m&dnkwat" alrl!nIJMt Thom low r on Y■n irel IyOr AppNra61a1wa wm aRiMrr on ygtCf♦fltY�*Iva1u Custarner S gnatur* Datta Driver Signature Date I I 4;int Drives Name 1 Print Nanti°