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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-8(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1.800-727-2876 FOR ACCOUNTING CALL: 2989322 562-231-1550 WORLD ®IL ENVIRONMENTAL SERVICES- H TEC OF CALIFORNIA - LOUISE AVE 7300 CHEVRON WAY,DIXON,CA 95620 2050 E LOUISE AVE 1-800-727-2879 a 2050 E LOUISE AVE WWW.WORLDOILCORP.COM D LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 LpTHROP., CA 95330 T (209) 858-4110 (209) 858-4110 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES Re /-2-V 12CII17-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/.MANIFEST# PART# DESCRIPTION QTY UNIT PRICE OTY P/U TOTAL a OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 2 $0.00 $0.00 BATCH TOTAL ; CASH REC'D: CHECK# . , WASTE DISPOSAL INFORMATION ^Ik; NON-RCF}A,y%A,AR,POUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 - NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 DESIGNATED TSDF: TES MARqGEMENI •-,r.- . AI,TE E T DF: ORUMS,P li_,;r'-" EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing b,tow,I hareby cergty Oat: (Waste oil generator/customer MUST check ONE of the following three boxes) Q 11)1 love not mixed any of the waste deschbeel above with any other hernrdoua waste,the total hallde rnnlant 0 LESS Nan 1,000 ppm,add Na Moto duels not contain any PCs,.1 have compiled whh the mquifereents of the applicable C,IINmlbpse0 ql management tegutagone fd determine this Is true.I agree to accept the additional chargee for the disposal of this waste It Ne infonrotfon I have provided shout Nle waste Is Meanest 0 as I have not maxed any of the waste seaehbed above with any other hours".wage,the Of.$halide contact is GREATER than 1,00o ppm,and Me waste does cel contaln my PCBea have provided proem dooumenbUon to World Oil Environmental Sarvlcas to mint the prelsumptlon that this ws.te wee mikes with other hexerdoua-gate.I an.to accept the additional charges for the disposal of this waste if the Inrormatbn I have provided about this waste Is Moonset p tl)Thts waste le hem a ink whlcM1 collects waste ell from Iwuoeheld"so d-youmea"(DIY)and/or coMPoonally exempt small pue Atty generator{CESOO)sources.To the best of my knowledge,the only waste oil contalnad in my DIY/CESOG collection tank Is coley fmm DIY andior CESGG scolded.I have not mixed this waste all with any other hazardous waste or waste oil from other sources.l dpma to accept the addltlonal charges for disposal of this waste It the InfomlatOn I have provided about this waste Is Inponect (Ali generators/customers MUST read the following text 1 stodgy Nal I have.program In piece td resew Ne volume and loaleaty of a.l.generated Ia the degree I have determined to be ecdnomicgly praddaehle and that I have selected No prodgceble method of Inalmanl,storage,to disposal currently available to me which minimizes the present and future threat to human life and the environment. This Individual signing In the spew eat IoM below on bef gin of--tomer represents and warr.nta that ho/Sha Me the eWhohly to bind customer,that the Jorge[,desert often.of waem and materiels am tragi and accurate as packaged,marked,eM IVDektl,an moay for IrenaportaUon In ac-Nance with epp(Iwhte state and tedarel regulations,and that customer,shall abide by the Stendntl Tomo and Carlstadt.on fee reverse idde of Mtn Service cans Sell-Ordure wife en associated hssamou--sets Amendat(eged,she specific a ddndolidined)are subject to an EPA Fee. the EPA pass-through fee add ssMnlehaUon of the skOnifect program. Th..e few vary based on Manifest type. Appilwble lees will appear me yoer billing Invoice. n � 6 �/;!6 ,L� Cus er ifgn re Date n r ignature Date 1rint1W Print Driver Name ( "