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ASBURY ENVIRONMENTAL SERVICES,DBA FORM NO.WOES002-B (5/18) FOR SERVICE CALL: SERVICE ORDER DIXON 1-800 727 2879 FOR ACCOUNTING CALL: NO. N 9086423 562-231-1550 WORLD OIL 7300 CHEVRON WAY DIXON,CALIFORNIA 95620 (800)727-2879 EPA#CAD028277036 Date !` �� Customer# F 3 I EPA# Address d�i"'f/4)L�'L '".� Commodity 14F .�.+��-' City ir�rl,`�'��'� Stat,t Zip i1='r j t Halides PPM Phol�e' �? �� L`f� Contact r"'I'ye Amount Cash ❑ Check# Notes: Waste Disposal Information ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 # .7 Q/ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 11— . ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(OILY WATER)STATE CODE 125 ❑ OTHER MANIFEST# l.1 d 1 "�R ( �•1/ { NEXT SVC DATE DRUM SIZE QUANTITY TRUCK NUMBER— DESIGNATED TSDF: ❑ WORLD OIL RECYCLING*2000 N.ALAMEDA STREET*COMPTON,CA 90222*CAT080013352*(310)537-7100 ❑ WORLD OIL ENVIROMENTAL SERVICES*2549 SCOTT AVENUE*CHICO,CA 95928*CAL000827844*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO II,LLC*1618 W.5TH STREET*CHICO,CA 95928*CAD980694103*(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA*200 DINSMORE DRIVE*FORTUNA,CA 95540*CAL930256136`(800)733-9043 ❑ WORLD OIL ENVIROMENTAL SERVICES*7300 CHEVRON WAY*DIXON,CA 95620*CAT080012602*(707)693-6008 ❑ YUMA YES LLC*2730 E.13TH STREET,YUMA,AZ 85365*AZR000515924`(928)643-8938 ❑ RAMOS ENVIROMENTAL*1515 S.RIVER ROAD*W.SACRAMENTO,CA 95691*CAD044003556*(916)371-5747 ❑ WORLD OIL ENVIROMENTAL SERVICES*1920 MORGAN RD,STE AES*CERES,CA 95358*CAL000393680*(209)541-1825 ❑ BAKERSFIELD TRANSFER INC.*1620 BRUNDAGE LANE*BAKERSFIELD,CA 93307*CAL000282598*(661)377-0308 ❑ WORLD OIL-SAN JOAQUIN,LLC*14287 E.MANNING AVE*PARLIER,CA 93648*CAL000102751*(559)498-0240 GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby cemfy that: (Waste oil generator/customer MUST check ONE of the following three boxes) (❑#111 have not mixed any of the waste described on the service order noted above with any other hazardous waste.the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have complied with the requirements of the applicable Callfomie used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste It the information I have provided about this waste is incorrect. (❑42)1 have not maxed any of the waste described on the service order noted above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does rot contain any PCBs.I have provided proper documentahon to World Oil Environmental Services to rebut the presumpticn that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste If the information I have provided about this waste Is incorrect. in#3)This waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG collection tank Is solely from DIV/CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste Is incorrect. (All generators/customers MUST read the following text) I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or dISPO.1 currently available to me which minimizes the present and future threat to human life and the environment. 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 description of waste and materials are true and accurate as packaged,marked and labeled are ready for transportation in accordance with applicable states and federal regulations and that Customer shall abide and be bound by the Standard7arma and Conditions on the reverse side of this Service Order. CustomerSignature Date Driver Signature Date I Print Name Print Drivers Name - t :I