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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DixON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA ' 1-800-727-2679 - SERVICE ORDER NO. FOR ACCOUNTING CALL: 2889154 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES.. H a 7300 CHEVRON WAY,DIXON,CA 95620 I TEC OF CALIFORNIA.-LOUISE AVE 1-600-727-2879 It2050 E LOUISE AVE 2050 E LOUISE AVE P WWVW.WORLDOILCORRCOM E TRANSPORTER EPA#CAD028277036 ,.T. LATHRORCA 95330 LATHROP, CA 95330 .0 (209)858-4110 (209) .858-4110 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES TEM 5 � CER-88 BARRY SCHEDULED-I -DATE pEQU1RED - , DAT ENTERED NEXT'_SER ACE.DATE CUSTOMER EPA. # BILL of LADING/MANIFEST# 5111342019 517/2019' CAL000415400 PAR pESCRIPTION " OTY UNIT PRICE QTY PN TOTAL OF1ElAL OIL AND GASOLINE FILTERS 1 $55.00 a i51r99- Obp165F RAL REPLACEMENT-NOCHARGE 1 $0.00 $0,00 - A 0,09-( .. TOTAL ECK# WASTE DISPOSAL INFORMATION CRT�F NOJQifl�FA.HYgp,6pS 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: YES MANAGEMENT,INC.,6500 US HIGHWAY 95,YUMA,AZ 05355,928-344-9028 - ALT" a; DF: -' , == anger. Sam—Read PA6�MS;F EMPTY DRUMS: FACILITY: BSC ' „'' •' '• GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) fly.ilpning below I tonality certify,that: (Waste oil generator/customer MUST check ONE of the following three boxes) Q a})I,Nyq nl rnyW any of Ne westo deecribed spore WIN any other hazardous waste,the total held.content Is LESS Nan 1,000 ppm,and the waste does not contain any PCga.I have compugdavltli�lro!•pupaf+pnb.1 the Applicable Callforto p peed oil management reputations to detarmlrp this is true.l spree to accept the Additional Merges for the disposal of this waste It the Igformation than provided about this waste Is Incorrect.'__ 0 021Mvaratmlasd"ofthawubdesulbedabove with Any other hazardous Ameba,Me total halide cpnleat to GREATEN thah 1,000.ppm,and thaweste does flat contain any PCBA.1 here provided proper deaglrlMltotlon to wpm(XI Envbonmemal Servkee to mint the presumption that NIA waste was mined with other hsmdous wool&I agree to accept the Additional Merges for the disposal of this waste N W Information 1 here provided about this wasto is Incorrect Q Id)Thh, As Is from d took which collocls west.oil from hatwahuld"do-0-younAlr(DW)and/or condNonNly exempt small quantity penerator(CESOG)sources.Tome beet of my knowledge,the only waste Oil c"Inad In my DIY/CESOG colloaon funk la'soley from DIY and/or CESOG sources.I have not mixed VIA waste all with any other huardoue waste or wasto oil from otldw souRA&,I Attila to Accept Ills additional charges for disposal of this waste If alta Information 1 have provided about this waste le Inconel (All generators/customers MUST readatlie following text 1 certify that 1 have s programin paw to reduce the volume and toxieNy,of weals generated to the degree I have determined to be economically pralicabfa and that I have seieatod the pfJoke eble method of treatment,slom9a,or disposal currently Available to ma which minhounts the present and futum threat to human life and Ne environment. Thllit individual signing In Ito space eet forth below on behalf of customer mpmeema and warrants that hNehe has the authority to bind wslu mer,that rite fomnl no dnanrlpdorw.l waste and materials us bus and sommate As pecabped,marked,and labeled,am ready for transportation In accordance with applicable elate and federal milvlstione,end that customer enall ablde by the Standad Terms AM Conditions on the reverse Aide of this Service Order. Servln w Orders with an associated hazordaua waste manliest(either she specific or consolidated)are vublect to an EPA Fee. Those fees cover Ne EPA pass-thm.gb Ise anti admini.o.tlon lite efanniteat program. These leas vary based on Manllaat type.Applicable fees will appear on your billing Involve. r Date Driver Signature Date /xi 'Print Name rint Driver Name