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RECEIVED <br /> FOP SERVICE CALL: SERVICE ORDER FORM NO.WOES004-6(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES.DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES- <br /> 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H <br /> I i-800-727-2879 , <br /> P <br /> P WWW.WORLDOILCORP.COM <br /> E TRANSPORTER EPA#CAD028277036 <br /> n <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME =BYHALIDESDATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# <br /> PART# DESCRIPTION OTV UNIT PRICE OTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: _ CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE.LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE- <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: _ <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> BY siBnln9 Delow I nerabr candy IoM: _ <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) 11 <br /> all l neve not ml:ad any of me waste daunt w.bova wun any Omer na:,rmas waste me mlal"alma comem Is LEss Ina"Laoo vpm.am me waam aces^ol[onlam am Pcec.I nage <br /> omplled wlm Ina ropulremenis of Ina applicable Calllornia usetl oil management regulellons to tletdrmine Inls is true.I agree to accept iha aatllllonal charges for the dlepoul of fa waste II <br /> ,h.,h 1 nave ph-d anon I-waam is m[omttl <br /> Q 131 M1eva not mired any of the wa: described above with any olner nazardoua waste,ine total halide content la GREATER man ml <br /> tots he,eppm.and the waste does not contain any PCBs. <br /> neve provldetl proper tlocamenlellon. -d!011 Envlronmenlal Services to rebut lha preaumDtio^met waste we.1—with olhhazertloua waste.)agree to accept the addlllonal <br /> chargee for the disposal of Ihla waste li •Inlormsllon 1 nave providetl about Ws waste Is incartttl <br /> Ia)—waste Is Irom n tents which collects waste oil Irom household"d,il youraell"roman—[ontllllonally esempt small guamlly generator tCESOG)sources.To Ina Dari al my <br /> knowlsWga,mo only waste oil to"tal"ed In my DIY/CESQGcede'-on tank le coley Irom.1 anNor CESOG sourcez.l have not mined 11,11--1 any other hazardous waste t,waste oil <br /> Irom other sources.1"gree to accept too addlllonal11,119"I. —1 of mla waste 11 Ina Inlotmallon nave provided about this waste Is In[orrttt <br /> (All gE ors/customers MUST read the following text <br /> awry td tdh,o ptogram in piece to reduce... <br /> .volume ano ;of wade generated 1 me ddgree nave aelerminad to be tt..111 ally pmctic—ontl mel nave cel«lea the - <br /> preclicable method of Ireelmenl,storage,or Olspoaal currently ave �to me wnl<h minimizes ine present antl tutor.Threat to"omen Ills end me envlranment. <br /> This indlvldual slpning In the apeco sal lotto below en behell of cualomer reprosenls end warrents Thal ndshe nae Ind aulno""to Dlnd cualomer,1hel the forgoing aescripllona of west. <br /> and materiels ere Iruo and eccurald es Dackegad marked,and labeled.ere ready for Ir: gallon in accordance with applicable slate and federal regulelions,and Inst cualomer ahsll abide <br /> Dy Ina Stnnderd Terms and Conditions on IM1e rovers.cid.of m,S.rvlce Order. <br /> $orvlco ordore with an esioclola0 hazardous weal.manliest(millet rile t-.1 EPA Fee.These lees cover the EPA para-th—gh 1—d adminislretion <br /> of the aMenllo.l program.Tne..foes very based on M-dest type.Appk,d,10 lees w. ,ur hitting Invoice. <br /> Customer Signature Date Driver Signature Date <br /> Print Name <br /> giver Name <br />