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ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES002-B (5/18) <br /> FOR SE-1VICE CALL: <br /> DIXON SERVICE ORDER <br /> 1-800-727-2879 <br /> FOR 562-31-1550 ACCOUNTING CALL: WORLD OIL ® No. N 9086427 <br /> 7300 CHEVRON WAY DIXON,CALIFORNIA 95620 (800)727-2879 <br /> EPA#CAD028277036 <br /> Date ;" Customer <br /> Customer ! - <br /> EPA# <br /> Address Commodity <br /> City State Zip Halides_ _PPM <br /> Phone Contact Amount <br /> Cash El Check <br /> # <br /> Notes: �-� r� <br /> Waste Disposal Information <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIVMIXED OILS)STATE CODE 221 <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)STATE CODE 1335 <br /> ❑ OTHER <br /> MANIFEST# ) - t <br /> NEXT SVC DATE DRUM SIZE QUANTITY C- -' TRUCK NUMBER <br /> DESIGNATED TSDF: <br /> ❑ WORLD OIL RECYCLING'2000 N.ALAMEDA STREET'COMPTON,CA 90222'CAT080013352-(310)537-7100 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES'2549 SCOTT AVENUE"CHICO,CA 95928'CAL000827844`(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO II,LLC'1618 W.5TH STREET'CHICO,CA 95928'CAD980694103'(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA`200 DINSMORE DRIVE`FORTUNA,CA 95540'CAL930256136-(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES"7300 CHEVRON WAY'DIXON,CA 95620 a CAT080012602-(707)693-6008 <br /> ❑ YUMA YES LLC'2730 E. 13TH STREET,YUMA,AZ 85365'AZR000515924-(928)643-8938 <br /> ❑ RAMOS ENVIROMENTAL a 1515 S.RIVER ROAD'W.SACRAMENTO,CA 95691 -CAD044003556`(916)371-5747 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES'1920 MORGAN RD,STE AES'CERES,CA 95358'CALOOD393680 a(209)541-1825 <br /> ❑ BAKERSFIELD TRANSFER INC."1620 BRUNDAGE LANE.BAKERSFIELD,CA 93307'CAL000282598-(661)377-0308 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC'14287 E.MANNING AVE'PARLIER,CA 93648'CAL000102751 `(559)498-0240 <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that. <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> (E/1)l have rat modid any of mahadde dandraso on the service oder noted above with am other haxmdouswazte,the tote)inside content is IBES than 1.04a)porn,and the waste do.not robain nany PCBs.I have complied with the rsquiremMms <br /> of the appllcabs CelXsma used oil managemern regulations to delennme this is tue.l agree to accept the dideadnel charges W the disposal M the waste if the infom,aoon I have pmviEed about this to is imushect. <br /> (❑Q)I have not mixed arty of the waste described on the service order Wed above with any other remrdous waste,the total halide Cwttant is GREATER than 1.000 ppm,and me waste does W contain any PCBs.I have dreaded Propar documentation <br /> W Wood Oil EnvironmentalServices W mbd the presumption that this waste was mired wish other hazadou,waste.I agree W eocapt the additional cringes for,the disposal of this waste it the infmmadon I head pmvded about this tests is incorrect. <br /> (❑93)Thus menta is hom a bank wricr WIRb waste oil from household"do-h-your aff-(DIV)and/or condibonelly Baempt small quantity generator(CESGG)sounnual To the beat of my knowledge,the only waste on cornered In my DIY/CESGG <br /> collectlantankasoklyfmm DIY/C Msoumes.lravenotmixedthiswastedlwhhany MhWh=douswasteorwasteoilfromodereoums IagmatoeccepttheadditionalchargazfordisposelMthiswasteiftheino tion Iravepmvidedabout <br /> this waste k and unhado <br /> (All generators/customers MUST read the following text) <br /> I cerb"aft I have a pmgrem in pkpeM reduce the volume and taucity of suets generated to the degree I have detmmined W W economically prectcable and Net I have sakcted the praminble matndd M <br /> treatment.Stpage•or dispo al mahmey available to and aeon minimizes Me presem and future threat to human toe and the eh ignmem. <br /> Tne indWidu51 suing in the spode set f ti h bell.on behalf ofCuAomer repre3¢Ms and warrants that he/she has the authority to bind CustamA,that the forgoing daecnptlon of mese and materials the true and s adidg e az packaged,manned and <br /> labeled era ready W transportation In acoctdance with applicauts state and federal re0ulatim s and that Customer shill abde and 0a bound by the StandeNTwms and Conditions on the reverse side of MIs S inn,Oder. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />