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FOR SERVICE CALL: ISIFF?ViCE 0 1DER I'ORM NO.WOES004-8(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DHA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUN 1 iNG CALL: <br /> 562,231-1550 WORLD OIL <br /> ' NVIQ0NHJ,,l"AL. u'RVICCS <br /> P <br /> P W4'WW.1'WUHLUOILCORPCOM <br /> F. TRANSPORTER I=PA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE SAT- .LIS I'CM=R SPA# - - FlILI_of LADING/MANIFEST# <br /> I <br /> PART# DESCRIPTION - -- QTY UNIT PRICE OTY PIU TOTAL <br /> i <br /> TOTAL <br /> CASH RECD: CHECK# - <br /> - ---- WASTE DISPOSAL.INFORMATION - <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE. LIQUID(ETHYLENE GLYCOL SOLUTIONS) STAKE CODE <br /> OTHER: <br /> DESIGNATED TSDF: - - -- - - - <br /> ALTERNATE TSllF: ------- <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: 13SC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By slgning below 1 hereby cortlfy that: <br /> (Waste of] generator/customer MUST check ONF of the following three boxes) <br /> 03)1 have:flat mixed any of the waste descrII)vd above rvlth any other ht^znrdous waste.the;tobil irxlldc olri, i .-: tlrar, :JM0 ppm.and the waste does flat contain ally PCBs.I have <br /> campllcd with the ru4tri menta of the applicable Cullfornla used oli managsment ret;:tintinn5 tr rt afennlne this, ir.::-.I t.: t 1 e--,apt taL addfdnnnl charges for the disposal of this waste it <br /> the Information I have provided about this waste Is InCvrract <br /> I T2;have stet mixed arty of the masts described above with nny rAh-hnzardoue waste,the tut41 halide cur,tcrit Is ti HVATE:H then I.11titl ppm,and the vinnte dne s not colAnin any PGBs.I <br /> have provided proper documentation to World 611 Environntentai acrvlrxs tri ro mt t;w uresunnption ttml thin•:fasts•ala:,mixoti with nthvr hazrrdous waste.I agree to accefat the additional <br /> charges for the dtsrk}arI of this viaefe h the informndun I have provided about tide rressiw la lsm urra-ur: <br /> [� !3)This waste is from a tank which collects Waste ail from 11all9etlal[:"du-ii-your_ulf"ON)and/or rrrnrtitionallyNx,s <br /> -lo <br /> t:smsll quantity ctenrxatar(GESCtG)sot,rcos,To the!leaf of my <br /> knowledge.the only woeto all cvrrs3lnud 111 111Y DIY/CLSLS.^a coflet-tiuti lance is saley from GIY nnanr GEsua sources,i ivive not mixed this waste ul)with any other hazardouu waste or waste 0 <br /> from otter sources.I agrao to 1=ept the additlnnal charges for disposal of tf)i:;twaste if the Snformatlon i i I.;•re provided abatd this waste is incorrect <br /> (All generators!costo'—Int'= 7=1�1a.IST react the following text <br /> I certify thet i have ri program in place to reduce the volume an[i toxicity of wrtste yerrFr-h. ''lave:etennlnod to f�e economically practicable aun that:have selected the <br /> practicable method of troatmont,storagtm nr disposal currently available tc Iris tvttici:;. i:,:' cod f;:lt,re threat to human life aatrt the environment. <br /> This individuEff signittg in the space set forth below on behalf of customer rupreaeni: - nor,. i:r:,:, tsim has tine authority to bind customer.that tine#nrgoung descript€ens of vlaste <br /> sou,e Steirels are true and accurate as packaged,marked,and labeled,are ready for-. ��r i n;tntioa in Liccorearin crit;,IppliCable stats and fedorai regulations.rind that customer shall abide <br /> Jy dad Slsrrderd Terms and Conditions on ttte;avers®&ids of iiia Service U;dr;r. <br /> Serrvica Orders with an nssorinted:razardcus waste manifest teithcr site stre;oI lc u, ;o,;sor[ciater:s a-t runie-i to an KIV.F"e - 71t,6v ret s c:vvlr the RRA class-throuq, fro ary a nd,ttinietration <br /> Of the erOAvnllevi l rognnn. Yhegr:Pees vary based on Manifest tynn. Appficabfe frzrs a-iil appear oil;"or nhiint,Invn1...+. <br /> Customer Signature _ Data Dr ver Signature — Date <br /> Print Name <br /> P-i:7t Driver Name -- <br />