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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-8(81181 <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727.2879 SERVICE ORDER NO. <br /> 5FOFJ 62-31--1550 TING CALL: fl� OR D ®IL 1 29?_r2?? <br /> ENVIRONMENTAL SERVICES,,. <br /> B7300 CHEVRON WAY,DIXON,CA95020 <br /> H TEC OF CALIFORNIA - LOUISE AVE 1-800-727-2879 <br /> v 2050 E LOUISE AVE WWW.WORLDOILCORRCOM 2050 E LOUISE AVE <br /> E TRANSPORTER EPA#CAD028277036 <br /> T LATHROP,CA 95330 LATHROP, CA 95330 <br /> 0 (209)858-4110 QC � (209)858-4110 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 'TEC805 CER-66 BARRY SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERE NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 6/2412419 6/18/2019 CAL000415460 <br /> PART i ., " DESCRIPTION QTYO UNIT PRICE CITY PIU TOTAL <br /> OF USED METAL OIL AND GASOLINE FILTERS 2 $55.00 $110-00_ <br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 2 $0.00 $0.00 <br /> BATCH <br /> TOTAL <br /> GASH Rgfio - CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NOWRCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NQl1f.RCrRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> "OR: TERS-COWAINOIG OIL)STATE CC10E 223 <br /> X Dg$)QN1 <br /> AeTED DTSOF: YES MANAGEMENT.INC.6500 US HIGHWAY 95,YUMA.AZ 85305.9211.740-Ma <br /> — —_ A=aunt Manager:Sam Read <br /> DRUMS P EMPTY DRUMS: FACILITY:_ BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby cavity M.L <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q H)I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS tan 1,000 pits,and the ended don not contain any Karl.l have <br /> compiled with the reautrementa of Ne applisetrie California used oil management regumisma to determine this is Irue.I agroo 0 accept Na additional charges for Na disposal of this waste II <br /> Ne Inforinotan I Npya provided about this coact*is incorreq <br /> Q 821 hove rat mixed any W the,waste dmcrllwtl above with any other hwilydous waste,the total halide content Is GREATEN Nan 1,000 ppm,and the waste down not contain ars,Man.I <br /> love provided proper tloeurneritetbn to World oil Environmental Services to rebut the presumption Net this waste was mixed with otter ha srdous waste.1 egne te accept to additional <br /> dregss for Ne disposal of this waste If W Information I have provided about this waste Is incorrect <br /> Q n)Trak waste is from a tank which ealiaeb waste all from household"do-it-youraell'(DIY)and/or conditionally exempt small Rasa ft generater(CEsaG)aderded,To Me,be}i of my <br /> enowlail the only weato all contained In my g1Y/CFSGG collection tank Is ashy from MY and/or CESCo waren.I hew nos mired tNe tete W with any of e,hamrdeue waide ar waste on <br /> Imre oNar sources,f agree to accept the addltonsl charges for dlsposol of this waste if the information I lave provided shard this waste is ineortast <br /> (All generators/customers MUST read the following text <br /> 1 cmWy that 1 have a program In plead to reduoo Na volume end toxicity of waste genemtad to the degree 1 hent delarmlred to be scone elcoily prsdlesda and that I neve selected Ne <br /> practicable mof cs!of trvabnonl,storage.or disposal currently available to me which minimized Ne preaenl and future threat to human Ilk and the eovlronmerM1 <br /> This Individual signing In No space set forth below on benalf of customer represents and warrants that Were hes the authority to blvd coe <br /> tomer,that One forgoing descrlptons we <br /> of al* <br /> and rrelensia are Mm send=..te as packaged,marked and libeled.ere ready for transportation in accordance with applicable stale,and federal wguleto.s,and Net edswer er.hali abide <br /> by the Standard Tome and Conditions an the reverse Wild of Nit Sorvice Order. <br /> rvice Ordure.[than ase Avery aseda hianifel(type. site !k Ov willalidafact yosubllin to..1111E ssaaayaL the EPA psendhrough leo and.dminisvaton <br /> nM Moes very dada on atanlreat type. Applicable Ims will appear on your billing inveic "•� <br /> Costo <br /> Is re Date Signature Date <br /> x--- - ---- <br /> Print Name Print Driver Name <br />