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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 9-800-727.2879 SERVICE ORDER NO. FOR ACCOUNTING WORLD �y® p N2801153 ®� 562-231-1550 OD OIL ENVIRONMENTAL SERVICES,. I TEC OF CALIFORNIA-LOUISE AVE 7300 CHEVRON WAY,DIXON,CA 95620 1.800-727-2075 to 2050 E LOUISE AVE 2050 E LOUISE AVE P W W W.WORLDOILCORP.COM 0 LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 LATHROP, CA 95330 o (209)85&4110 (209)8584110 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN 9Y HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# P T# Qr4 UN E CITY P/U OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 4 $0.00 BATCH. ; TOTAL CASH'ARO'Di CHECK# WASTE DISPOSAL INFORMATION NOWACRA HAZARDOUS WASTE,LIQUID.(USED DIU NIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUSAYASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: NON. a ZAR11"W cr t:[1I ID/F7 7 r+CONT IkINO OIl 1 STAT�CODF?73 DESIGNATED TSDF: YES Mme,INC.,6300 US HIGHWAY 95,YUMA,AZ 85365,928.344-9828_ ALTERNATE TSDF: _—__ CrOse' �1 Account Managar:Sam Read DRUMS PN: ` 9MPTY DRUMS: FACILrrY: BSC GENERATOR.WASTE-CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below l hereby ro fly,Nat: (Waste oil generator/customer MUST check ONE of the following three boxes) Q 01)1 have not mixed any of the waste described moo.with emy cuum hseardous Waste.the total halide cement Is LESS than 1,000 ppny mid No waste dodo not contain any FICBa.I have compiled with the requiremome of Ute applicable California used oil management regulations to tlelatnine this Is free.I agnea to accept the additional charges for the disposal of this wale it the Intannsdon I have provided about two waste is Incorrect,. Q 021 have not In aedsey of the waste described above With any ogle haun00ae WOalO,the tots'halide content la UNEATIT,than 1.000 ppm,and Ice Wanla does rat coeein any PCBs.l bevo provided proper documentation to World Oil Fnvlroamontal Servlcee to-abut the pea nnefulon that Uda waste nee misadwith othc tlaxadalla waste I agree a accept trio additional Magas for he dlaposal of U!la waste It the InformaUan 1 have provided more that waste Is Incorrect (] ")This waste is tram a lank which collects,%vena dl from household--dell-yolmscU"(OIY)endlor eondilional!y examplemsll quantity girrummor(CESOG)sources.To the loot of my knowledge,the only wale all orntalned In my DIY/CEBOG collection tank la moloy,froth OIY and/or CESOG sources.I have not mixed this waste oil with any other baIDkaua waste W orate OR from other sources.l agree to accept Ira additional chargee for disposal of this waste U the Irformadua 1 Lave pravielebsbnal this waste Is incorrect (All generators/customers MUST read the following Text I certify the I have a program in place to reduce the volume end toxlchy of Wacto generated to the degree 1 hsvo dsicrmiaad to he rem:conically creeical#e and that I have Wanted the practicable method of treatment,storage,or disposal currently available to me which mlnlmizns the present a nd teens thr.-W to hea"11 IIIc end the crwimmitent. This Individual signing In the apace at forth below an bebell of customer represents aid warrants Ibct hash,ha;!Yo aolilodty to bind medumaa that the forgoMy deuriplfmm of wade end materials ae true and o4cura(0 me We marked.gad iablbd,ma Rady fat ItMSY.ala801f Ip C cordmir<-wig:m+pllert,12 a:mA mid aademi regulations.m1a Nutt eas!amel ehnll abide by the Sandal Terms and ConNUvns en Ire reverse aide at this Servleo Order. Swyice,Orderx.Uh an aeSOGlead twordVYe wade man!rest sellher site specific,or eoneetideevr)m;,subI.V man ERA F::e. Titcac tea:v::vo:the EPA i:eao-threugh tiff rad wiflu'ia!rallen al the em.num;t program. w ogra . There foes ay based on Montreal typo. Applicable tons win eppeta air Voir uinng h,vdc.r. x� �.'�- ---- .��JL�1_L' /_//-/.•i ... CuslunwSignature Datc •" .;1•-; Dsstc r y ,