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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-6 (8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR AGGUlJNT1NG CALL: WORLD OIL 562-231-1550 ENVIRONMENTAL SERVICES- 7300 CHEVRON WAY, DIXON.CA 95620 H 1-800-727-2879 P WWW,WORLDOILCORP.COM F TRANSPORTER EPA #CAD028277036 0 T 0 CUSTOMER # PURCHASE ORDER # ROUTE# TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL TOTAL CASH RECD: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: f DRUMS P/U: EMPTY DRUMS: _.- FACILITY: _ BSC_ GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) 13y signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) U 41)l have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,o00 ppm,and the waste does not contain any PCBs.I have compiled with the requirements of the applicable califonUa used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste it the Information I have provided about this waste is Incorrect 02 1 have not mixed any of the waste described above with any other hazardous waste,the iota)halide content is GREATER than 1,000 ppm.and the waste does not contain any PCBs.I 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 charges for the disposal of this waste ii the Information I have provided about IhIs waste is incorrect -J 03)This waste Is irom a tank which collects waste oil from household-do-it-yourself-(DIY)andfor conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil Contained in my DIY!CESOG collection lank is coley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste all irom other sources.I agree to accept the additional charges for disposal of this waste it the information I have provided about this waste is Incorrect (All generators/customers MUST read the following text I certify that I have a program in place to reduce the volume and toxicity at waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment.storage,or disposal currently avallabie to me which minimizes the present and future threat to human life and the environment. This individual signing in the space set forth below on behalf of customer represents and warrants that he/she has the alltharlty to bind customer,that the forgoing descrlptions of waste and maleriais are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and thal customer shall abide by the Standard Terms and Conditions on the reverse side of this Service Order. service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees cover the EPA passthrough fee and administration of the ehtanifest program. These fees vary based on Manifest type. Appficabfe fees whl appear on your blllEng invoice. Customer Signature Date Driver Signature Date Print Name Print Driver Name