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SERVICE CALL: SERVICE ORDER FORM NO.WOESn04-Ei 4/17 SUN OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA ( ) 1-800-727-2879 SER'JICE ORDER NO. FOR ACCOUNTING CALL: 562-231-1550 - WORLD OIL ENVIRONMENTAL SERVICES- 5 7300 CHEVRON WAY,DIXON CA 95620 JfrFY LU;—;;:#.A1322 1-800-727-2879 8ROADBA5; INC P 500 E KETTLEK6AN RLI. WWW.WORLDOILCORP.COM 14-111 SN'.JK ST E MONTHLY BILLING WO&OF T LODI. CA 96240 TRANSPORTER EPA#CAD028277036 VIEST areCRAiViE='aTO, CA M5 G1 0 (200) 375-1 1i:5 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDEP.TAKEN BY HALIDES JIF675 DIX-95 �� CSCAR [axe a DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA If BILL of LADiNGlMAiJIFEST 5t 712�'i 8 CAL0001526 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL VV OILY WA BR PER GALLON PJKIP ft.rvvh7EfiFIZQIV iP..► BATCH* pass Strwm CiiV TO DK DIXON- DK110442 EXPIRED it°�VI f " ACMIL ML!!ad±r Sllf,Garay TOTAL CASH RECD: CHECK WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATEDTSDF: a ' 1' !2CO q,.5.4 ALTERNATE TSDF: DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) By signing below I hereby cenify that (Waste oil generator/customer MUST check ONE of the following three boxes) Oel,1 have not mired airy of the waste described above With any other hazardous waste,the total halide content is LESS than 100o ppm and the waste does nut contain any PCBs 1 have complied with the regitirerrienI,of - the applicable Cahfornw used oil manaWmem regulations to Bete rime this is true.l agree to accept the additorul charges for the disp-al ciflhis vested the mfumwtion l have provided about this waste is irri:urmct Qe2 I have rot mixed any of the waste described above with any other hazardous waste.the total halide content is GREATER than 1.000 ppm,and the waste does not contain any PCBs I have provided proper documentation to Worts Oil Environmental Serviceslo rebut the presmnption that this waste was mixed with cher hazardous waste I aryee to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect i CD031 This waste rs from a collects which colls waste oil from lrousehWd'dort yourself'(DIY)andior conditionally exempt small quantity generator ICESQGI sources. th d myces.To the best knowledge. the only waste oil conWirsed in my DIY,CESQG collection lank n soley from DIY and+o,CESQG sowces.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources I agree to accept the addmonal charges for dsposal of this waste if the information I have provided about this waste is incorrK I (All generators/customers MUST read the following text and check the associated box.) MM)If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxicity d waste generandt m the Aegye,e I have clew,mmed to be econom-iffy practicable—I that I have selected the procurable method of ueatmenc storage.or d,sposal cunenlly avivlable Ip me which minimae,the present and lurwe lhreat to human file and the enw,onnW.I.Or.if I am a small quanuly generator,) have made a good faith effort to minimize my waste generation arta select the Lest waste management method thaws available tome th,il I can AUlid- This individual signing in the space ser forth below on behalf of Customer represents and warrants that heKlw has Ire authonly to birid Customer.that the fmgomg descripwiirs of waste and materials are true and accurate as pa,kaged,marked and labeled,are ready for uansponauas in acwdance with apple-bre sate and federal wgulubons,and that Customer shell abide and be bound by the Standard Terms and Ccoxhllons on the reverse seed IN,Service Order. fl'lr Signawre Date Driver SOnatu :� Date vi" - �° nor Print Name t Print Drivers Name