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FOR SERVICE SERVICE ORDER <br />DIXON OFFICE ASBURY ENVIRONMENTAL DBA <br />.i0 <br />FOR ACCOUNTING CALL: <br />562_-231-1550 <br />worILD OIL <br />ROUTE # <br />TRUCK It <br />t';6i4T]ZZ NAME <br />ENVIRONMENTAL SERVICES - <br />S <br />H <br />7300 CHEVRON WAY, DIXON, CA 95620 <br />1-800-727-2379 <br />P <br />P <br />WWW.WORLDOIL.CORP.COM <br />� <br />TRANSPORTER EPA # CAD028277036 <br />T <br />CUSTOMER EPA # <br />0 <br />FORM NO. WOES004-B (3/18) <br />SERVICE ORDER NO. <br />CUSTOMER # <br />PURCHASE ORDER # <br />ROUTE # <br />TRUCK It <br />t';6i4T]ZZ NAME <br />-ORDER 'OAKEN BY <br />4HALIDES <br />DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA # <br />BILL of LADING/ MANIFEST # <br />PART # <br />DESCRIPTION <br />QTY <br />UNIT PRICE <br />QTY P/U <br />TOTAL <br />- <br />TC 117AL <br />vim_ <br />CASH REC'IJ: CHECK # <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LiQUiD (USED OIL/MIXED OILS) <br />STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_.__..__ <br />OTHER: <br />DESIGNATED TSDF: ---- -- __�^... __. ------ <br />------=-------- <br />ALTERNATE TSDF <br />----- ----- -- —.._.� <br />DRUMS P/U.__--- - EMPTY DRUMS: -- I ACI 'F <br />GENERATOR WASTE CERTIF'ICATIO <br />By signing below I hereby certify that: <br />(Waste oil g?-.ne a or/customer MU <br />[1 #1) 1 have not mixed any of the waste described above with any other hazardous waste, th( <br />complied with the requirements of the applicable California used oil management regulations <br />the information t have provided about this waste is incorrect <br />Q #21 have not mixed any of the waste described above with any other hazardous waste, th <br />have providedproper documentation to World Oil Environmental services to rebut. the presu <br />charges for the disposal of this waste if the Information i have provided about this waste is t.1 <br />In any PCSs. i have <br />;poral of this waste if <br />J� <br />ontain any PCBs. I <br />:opt the additional <br />0 0) This waste rs from a tank which collects waste oil from household "do-it-yourself' (DI ro the best of my <br />knowledge, the only waste oil contained in my DIY/ CESQG collection tank is coley from DIY dous waste or waste oil <br />from other sources. I agree to accept the additional charges for disposal of this waste it the <br />(Ali generators/ custorr <br />I certify that I have a program in place to reduce the volume and toxicity of waste generated ive selected the <br />practicable method of treatment, storage, or disposal currently available to me which minim <br />This individual signing in the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer, that the forgoing descriptions of waste <br />and materiels are true and accurate as packaged, marked; and labeled, are ready for transportation in accordance with applicahle state and federal regulations, and that customer shall abide <br />bythe Standard Terms and Conditions on the reverse side of this Service grder. <br />Service Orders with an associated hazardous waste manifest (either site specific or consolidated) are subject to an EPA Fee. These fees cover the EPA pass-through fee an(] administration <br />of the eManifest program. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br />Customer Signature Date Driver Signature _.__. Date <br />Print Name Print Driver Name <br />