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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (4/17) 1-800-727-2879 ( � -. 0 SERVICE ORDER NO. FOR ACCOUNTING CALL: 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES,~ " 7300 CHEVRON WAY,DIXON CA 95620 !It i Y L.Ufii f>'ia'I't3 Lir ��ai 1I1.F INC1-800-727-2879 P 41340 I' HAtdIWA- I-N 1471 SHORES ST E Ir1t:hl 11-11.t F_31t_l.!t! 1111! WWW.WORLDOILCORP.COM T ` r`'?C K104, CA %)i10 TRANSPORTER EPA#CAD028277036 WEST"8.4CRAMENT0, GA SaW?1 ° igiM 375-1153 -r CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES �� 1 �t/ 11A1f OtII F-171-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# PART# DESCVIPTION QTY UNIT PRICE QTY P/U TOTAL 16ir-ALLS'-N Oil DRI-!!ri (I.'F c;t'�NI 1iIO4�1Ei�1 r i'AIAR FILIFf8S I'E ht DRUM •1.ar t r!irrt- TO t(*PrK SIDE HAI',I I W-04 tIONE MTICH a ?GCrAX,Oht (.X1041'' Xi'-'IRE f TOTAL CASH RECD: CHECK#-____--- xrtt�l+a, 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: — DESIGNATED TSDF: ALTERNATE TSDF: DRUMS P/U: _ EMPTY DRUMS: FACILITY:___ BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By sagrwnq be",I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) Q#1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LLY,than 1,000 ppm,and the waste does not contain any PCBs.I have complied with the requirements of the applicable California used oiI management regulations to determine this is true.l agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect O#21 have not mixed any of the waste described above with any other hazardous waste,the total halide content h GREATER than 1.000 ppm,and the waste does not contain any PCBs.I have provided proper documentation to world CAI Environmental Services to rebut the presumption 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 C7#31 This waste is from a tankwhieh collects waste oil from household`do-it-yourself( Iy)Dand/or conditionally exempt small quantity generator(CESCIG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESCG collection tank is soley from DIY and/or CESOG sources.I haw not mixed this waste nil with any other hazardous waste or waste oil from other sources.l agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect r-�y (All generators/customers MUST read the following text and check the associated box.) 1 0#4)if I am a large quantity generator,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 econcmically practicable and that I have r selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment;Or,if 1 am a small quantity generator,I haw made a good faith effort to minimize my waste generation and select the best waste management method that is available tome that I can afford. 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 and materials are true and accurate as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse side of this Service Order. 90 'd Customer Signature Date ! Driver Signature.••--"' at Print Name Print Drivers-tame