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FOR 5ER'0C-;E-CALL., SERVICE ORDER DIXON OFFICE ASBURYENVIRONMENTAL SERVICES, DBA FORM No.WOES004-B SERWCE-Ol NO, PARLIER _dO 559-498-0240 CfilCO AF- 800-733-9043 WORLD OIL ENVIRONMENTAL SERVICESTI 1300 SOUTH SANTA FE,COMPTON CA 90227 H 0,1,&Di- L!FT'T-.RUrKdNC, CID63,j i F" RHONDA C�31J3? 3" LOS ANGELES OFFICE OsAi A`A, P 1-800-974-4495 T RACY; CA fK�,2t;4 TRANSPORTER EPA#CAD028277036 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 9 ffll of LADING/MANIFEST PART# DESCRIPTION QTY UNIT PRICE QTYP/U TOTAL 55 GALIL034 Of4 TOP �',Ii+'JMr S'0 OILY, SOLit),-S PFR DRUM 495 RAT_11H TOTAL CASH RFC'D-,_ 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: DESIGNATED TSDF:_ ALTERNATETSDF: DRUMS P/U EMPTY DRUMS: FACILITY:--- BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) By signing below hereby certify that: (Waste oil generator/Customer MUST check ONE of the following three boxes) 1 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 PCl 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 if the information I have provided about this waste is incorrect =#2 1 have not mixed any ofthe waste described above with any other hazardous waste,the total hall content is GREATER than 1,000 ppm,and the waste does not contain anv.l I have provided proper documentation to World Cii Envfroorriental Services to rebut The PresAmPtTon that this waste was mixed with Tither hazardous waste.I agree to accept the additional Charges for the disposal of this waste it the information i have provided about this waste Is incorrect =03)This waste is from a tank which collects waste oil from household'<Jo-rt-yeurself"01Y)and/Gir conditionally exempt small quantity generator ICESOGl sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG collection tank is coley from MY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oij from other sources.I agree to accept the additional charges for disposal at this 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.) 'll if I am a large quantity generator,f certify that I have a program in l to reduce The volume and toxicity of waste 9 'selected the pra ,enerated to the degree I have determined to be economically practical and that!have cticable method of treatment,storage,or disposal currently available to me which ml the present and future threat to human lite and the environment;Or,if am a small quantity generator,I have made a good faith effart to minimize my waste generation and select the best waste management method that is availaffie to me that I can afford. This individual signing in the space set forth below or behalf of Customer represents and warrants that he/she has the authority TO bind.Customer,that The forgoing descriptions of waste and materials are True and accurate as packaged,marked and labeled,are ready for transportation in accordance with applicable state and l regulations,and that Customer shall abide end be bound by the Standard Terms and Conditions on the reverse side of this Service Order. if- Customer Signature Date Driver Signature Date Print{Name Print Dl Name