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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: C) " WORLDOIL N2922081 <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> S 7300 CHEVRON WAY, DIXON,CA 95620 <br /> H HONEST AUTO SALES- HONEST AUTO 1-800-727-2879 <br /> P 595 C 1 TSI STREET WWW.WORLDOILCORRCOM 595E 1TH ST <br /> ° TRACY, CA 95376 TRANSPORTER EPA#CAD028277036 <br /> T TRACY, CA 95378 <br /> o (209) 207-9554 (209) 207-9554 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> HON621 R UTE 110 gco.3 ABE Quintana <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 6110/2019 CAL000345565 (a(F j <br /> PART# DESCRIPTION CITY UNIT PRICE CITY P7V TOTAL <br /> \NOSC USED OIL SERVICE CHARGE 1 $65.00 $65.00 <br /> VVO USED OIL/ MIXED OILS 220 $0.00opl� $0.00 <br /> BATCH <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> h NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: ASBURY ENVIRONMENTAL SERVICES-CERES, 1920 MORGAN RIO„CERES,CA 95358(209)541-1825,CAL000393580 � <br /> ALTERNATE TSDF: <br /> Cross Streets: Account Managt4vy - <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRI <br /> By signing below 1 hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> q3 y1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS then 1,000 ppm,and the waste does not contain any PCBs.I have <br /> compiled with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If <br /> the Information I have provided about this waste Is incorrect <br /> Q #21 have not mixed any of the waste described above with any other hazardous waste,the total hallde content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs.1 <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste is Incorrect <br /> Q #3)This waste la from a tank which collects waste all from household"do-It-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESOG collection tank Is soley from MY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.I agree to accept the additional charges for disposal of this waste If the Information I have provided about this waste is Incorrect <br /> (All generators/customers MUST read the following text <br /> I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically precticable and that I have selected the <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This Individual signing In the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees co r the EPA pass-through fee and adminlstration <br /> of the eManlfest pro r sae f vary based on Manifest type. Applicable fees will appear an your bllling Invoice. <br /> -1pl 6- <br /> Customer Signature Date driver atur Date <br /> l— <br /> jrn d1�/1r <br /> Print Name Print Driver Name <br />