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--FOR SERVICE CALL: SERVICE 0111IDL,R FOnM NO. WOL:S004-B(8/18) <br /> AXON OFFICI= ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> 562-2ACCOUNTING CULL: � WORLD OIL <br /> 562-?.u1--1550 <br /> [:NVIk''ONy1L'N-IAL SERVICES <br /> S 7'00 U F-VI10N VVAY. DIXON.C.A 96620 <br /> I! <br /> P <br /> WWW.WORLDOILCURRCOM <br /> D TRANSPORTER EPA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROU rE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATF- CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> PART# DESCRIPTION �— QTY UNIT PRICE FQTY PIU TOTAL <br /> r <br /> TOTAL <br /> CASH RECD: ---- CHECK# -- <br /> WASTE DISPOSAL, INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXE]OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE CLYCOI_SOLUTIONS) STATE CODE <br /> OTHER: _ <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: — -— --- — <br /> DRUINS P/U:__. EMPTY DRUMS:_ FACILITY:__ -- - 8SC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BO)} <br /> BY slrining below I haruby certify that; <br /> (Waste ail generatorlcustomer MUST cel r ONE of the following three boxes) <br /> #1)1 have not mixed any of the wnnte doacribed above wlei mny utlioi r! .si cl4us WlRte.til t! I --55 than!,wa ppm,and the waste docs not contuin any PCes.r i+ave <br /> complied with the requirements of the applicable C1111fornia used nil„r, ,i-�rrreltt r-yulstions t+j r'1': nl*ll t,t!e.I:rgrc,to accept tho ndditlonal charges for the diaposal of this waste if <br /> the In€onaation I have provided about thle waste-Is incorrect <br /> 1 S2 1 have not mixed any of the waste describes;shove with any c:tir i_!p=us we-+,at-:,the tr. -i- .i ^nntr it w e r E-ATt fi than i.nrx7 p r stnr4 the waste dews not contain any PC6s.i <br /> have provided proper documentation to World oil[nvironmvntni err _ Pm. <br /> ehar,@s fnr the.disposal of tilts waste if the Information I have nrcvir trabtn,ie iJt=-urrcr -� t; tam ' 'a�onlrc+!�:rlth other i!nznrdoua waste,i agree to accept the additional <br /> )Tills waste iffrom a tank which coiiecta waste oil from huuashohl-do-It-yot l'"f' Oily)n!=•t'a,wndlliunaliy exrrt!pt small quantity ttoruarator(CFSQG)snufCo&To tine best of my <br /> know!bdyn,th4�only xesec•ul!cnntalrreU In my D1Y/CC$QCm L-ulleCt!ell trek le ooloy from tr"r"IrYnr cE7tx;"Our—I have not mlmw thlb waste oil with any bi4ei PuzaCfious w2Sfn or v:asts oil <br /> tram other sources.I agree to accept the additional charges fo'd1sposal of thin waste f the I!If01-+ug1on I have pt'nvlded arbotq this waste is incorrect <br /> (AEI generato elf t irl the following text <br /> certify that!have a program in place to redntx;file volume and toxicity c !- <br /> practicable motitexi of ttnatmant,stereo@,or disposal currently avnil bie to nu yr net,n]Inisr] `-nrte 10 ba eConomlcaliv Praeticabi0 and that I hevp selected tf]e <br /> threat to I,ur an[Ito and the environment. <br /> This individual signing In the space set forth below on Uehalt of customer repres,-itsi- <br /> Bad n+¢terials are true and accurate as packaged.nuirked,and laheied,ara reedy for trnn^r m�Rh aertfttxlty td hl[td cltBtamer.that filo forgt:Ing descriptiurs of waste <br /> Cyr the Standard Terms and Conditions on the reverse side of this Servlce Order. - appilcabia StAts and federal r9gui8tions.and that customer shall abide <br /> uervtce Orders with ail associated hazardous 1,.stn manifest(aithe!site:gr;rtf's+;or conao;i <br /> of the eMnnlfest program. These fees vary based on A@anrfest typo. Applrr,::;hla Imes vein a;r_-, :,: ',,,';,;_1 Fee. These fiten Cover the RPA pans-through fce and administration <br /> Customer Signature - — Date Lrl v;-Signature - — — — — <br /> Date <br /> Print Name — <br /> A driver Name — — <br />