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woR sERvicl LL: SERVICE ORDER DIXON OSCE ASBURY ENVIRONMENTAL SERVICES, DBA FORM N0:WOES.004:8 (4/17) J-800-727-2879 USO SERVICE ORDER NO. FOR ACCOUNTING CALL: 1tVopiYI 562-231-1550 P12616741 R AF 1 165 ENVIRONMENTAL-SERVICESib: s FIRESTONE Qa$74f� 7300 CHEVRON WAY,DIXON CA 95620 u ST 1 "l"}uRCiE-:MGMT-FIRE: H 1-800-727-2879 P 72fD 1 . HAMMER LANE ' 01175 MAIN S1'I T,SUITE 420 p WWW.WORLboiLCORP.COM STOCKTON CA 85210 TRANSPORTER EPA#CAD028277036 t1:3CC►;TX 704 0 ( )851-240 (072)464.0004 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES FIFW7 CER,86t_ $. HEDULED4 DATE REQUIRED DATE ENTERED. NEXT SERVICE DATE CUSTOMER EPA'# BILL of LADING/MANIFEST# PART# DESCRIPTION .QTY UNIT:PRICE QTY P/U TOTAL -D/t Rt( OAk.;I. METAL DRUMa 4 BRAKBRAKE FLUlD,F� R'D Ul1i1 ' 1 f ATCH Cro asTOTAL CASH RECD: CH E.: ' Acct Mahal i ®a Iy. WASTE DISPOSAL INFORMATION.. NONACRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON RCRA HAZARDOUS WASTIIFIOUID•(ETHYLENE GLYCOL SOLUTIONS) STATE CODE -O.PER; 1)LSI6NAfEDTSDF: ALTERNATETSDF: I DRUMS P/U: EMPTY DRUMS FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator customer.MUST check ONE of e 6ilow'ing three boxes) O#t)I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is,LESS than 1,000 ppm and the waste does not contain any PCBs.I have complied with the requirements of the applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste Ifthe information I have provided about this waste is Incorrect 11{{ O#21 have not-mixed any of the waste described above with any otherhazardous waste,the total halide content is GREATER than 1,00o ppm,and the waste does not contain any PCBs.I - •..t have provided•proper m docuentafloJt toworld 011'Envkonmerital Services fo rebut the presumption that this waSfe was mixed with other hazardous waste.I agree to accept the additional chargee for the Slisposa(of this waste tf the lnfomtatlon!'have provided ibotit this waste is kicorrect 171R3)This waste is from a tank which collects waste oil from household"do-h-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only wasteoiKontained inmy DIY/CESQG collegtion tank is soley from DIY and/or CESOG sources.i have not mixed this waste oil with any other hazardous waste oriwaste oil from other sources.I agree to accept the additional charges for disposal of=waste If the information I have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box:)' #4)K I am a large quantity generator,I.certifythati have a program In placeto reduce the volume and toxicity of waste generated to the degree i havedetemuned to be econbi nically practicableand that I have elected the practicable method of treatment;storage,or disposal currently available tome which minimizes the present and future threat to human Rf®and the environment Or,if I am a small quantity generator,I 111 ve made a good faith effort to minimize my waste generation and select the best waste management method that is available to me that i can afford. This individual signing in the space set forth below on behalf of Customer represents arjtfZrarrents that he/she has.the authority to bind Customer,that the forgoing descriptions ste and ma Isis are true and accurate as packaged,marked and b_eled are ready for transportation in accordance with 10-cable state and federal regulations,and that Customer shall abide and be bound,by the S and Terms a Conditions on the reverse t side of this service Order' CuIV storm rSi n r Date Driv r5ignature Date Print Name Print Drivers Na