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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8;18). DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA ,1.800-727-2879 SERVICE ORDER'NO. FOR ACCOUNTING CALL 5 ®ISL® ®IL 52-231-1550 V''' ENVIRONMENTAL SERVICES. 9 7300 CHEVRON WAY,DIXON,CA 95620 H 1-800-727-2879 toTEC OF CALIFORNIA -LOUISE AVE P 2050 E LOUISE AVE WWW,.WORLDOILCORP.COM 2050 E LOUISE AVE o TRANSPORTER EPA#CAD028277036 T LATHRORCA 95330 LATHROP, CA 95330 (209)858-4110 (209)858-4110 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# iCONTACT NAME ORDER TAKEN BY HALIDES TEC605 -1 q , CER-86 aQl BARRY SCHEDULED-I DATE REQUIRED •DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 31.13=19 315/2019 CAL000415460 PART# DESCRIPTION OTY UNIT PRICE QTY PAI TOTAL OF USED METAL OIL AND GASOLINE FILTERS 2 $55.00 .a $110.00 OFOR OIL FILTER DRUM REPLACEMENT- NO CHARGE , 2 $0.00 � $0.00 'BATCH TOTAL CASH RECD: - CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: DESJ(3NAT HAZARDOUS WASTE.SOLID(FILTERS CONTAINING OIL)STATE CODE 223 ALTERNATE TSDF: YES MANA0EMMTTTNC:1`6500 US RGRIV AY'95,YUMA,AZ 85985 H2�3d&6H2ff — -- ��._ f055 —_-------`_' - - "---- -Acdou'nf-Manager."Sero-Ftezd- DRUMS PN• EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby c¢rtlly(hat: (Waste oil generator/customer MUST check ONE of the following three boxes) 0 01)1 have not mixed any of the waeta descrlbad above with any other hazardous waste.the Iota]halide Gamont Is LESS than 1,000 ppm,and the waste time not contetn any PCBs.I have compiled with the roqulremerda of the applicable California used ail management:¢gulatlona to dotwmine Ihla Is tnle,l agree to accept the additional charge,for UID disposal of this weals If the Information 1 have provided about this mate is incorrect a 021 have not mixed any of the waste deocriho!above with any egrvr hazardous waste,the total halide centen!Is GREATER than 1,000 ppm,and the wase time not contain any PCBs I have provided proper documOntatlon to World Oil Envimr.menAil Sofv' as 10 rebut the presumption first INS)vast.vm,mixed whit other hazetdous wnata.I agree to accept the addltionst charges for the disposal of Iwo wade lithe Inform lien I here pro•Admr about fhie weatd is Incorrect 0 03)This waste is hem a tonk which ecliecic rest,oil frim heb;gh¢I11"d0 lbyoursulf'(01Y)nn('1or car,J'ticmuiy axxr,.F!small quantity generator ICESOO)seance.To the haat of my snawladgq the only waste all contained In my DIY/CESC G aollartlon tariff IS soky ftcm My and/or CESOG ccu:COs.I have not mlxad Ihis wash,oii wllh any other hazardous waste.,..Ste all from Other sources.],thea to accept Cro additional charges tot disposal of this waste if We Inlalorntlon I hpvc pt-wM.ed about this waste is Incorrect (Aft a inerators/customers MUSTread the following text . i Scruff,that 1 have a program in ower.to reduce Gm vcl::nn:ud toxlcity of c;ueg eumratOd to the degree 1 Imvn J•nemiced to Co ceonmNm:lly praclieaele and Met I have soleetev the Finalicahle magnad of traa::m:nt,mertJe,m diEl"Ital ctlnuni.,,:railemi,✓,gra rabic.}miniaJx:s:C:r 111,0;:1 eau ftduro ttv t.t 1.halms,We Intl the CavimnmanL This Individual sIgr lag in the up¢ec sat 1,nit Ir-dal at b.'.a li at cczto:,.":I Chat pcRrtc:::u lire autitoriiy to!Inc Gusto:ger,that the forgoing tlesariptions of mato and nlaadaliere aue ens aenoam ae VaN:coca:.:.:::a::, 5llt:eieo.arc rad^lar ecnars:::ba In aauei:n:c_with appbcatrh a0va card federal reg¢Indoce,and 0ateuatomer shall¢Ila¢ F,y Ih0 Etardnrd Terms anE COndhbna or.:ire r=•:cac reit:.cY::�.3a:ci:•:^....r. C -_ - .,'.^ tl.. ,u 0!e aee.:.li mL_• •C c': of lir pian tP i:; n a. , I e :.. L..• ,. �: -.. �:' .. - rt L;^10 i'•,nP -_ y r