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FOR SERVICE CALL: SERVICE ORDER <br /> FORM NO.WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-8001-727-2879 <br /> FOR ACCOUNTING CALL: N3295344 <br /> 562-231-1550 0 WORLD OIL <br /> ENVIRONMENTAL SERVICESTM <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H <br /> I A N T Cr,.,l;�41 EN T:7-R,; R't S E S LLC - L A T H R OP 1-800-727-2879 ANTONIN! 2NTERPRISES LLC- ANT 0 <br /> P 7;-,-' D'AR PO BOX 8468 <br /> P I D �CY P,*K,,"v'Y WWW.WORLDOILCORP.COM <br /> E <br /> D iL A 7 HiR 0 P,CA 9 5'3 3 0 TRANSPORTER EP A#CAD028277036 <br /> T OCKTION, CIA 95215 <br /> 0 <br /> (209) 466-4900 <br /> CUSTOMER # PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN"FIC-08 ROUTE 00C <br /> 1-9.1 JOHN SCHEDULED-1 <br /> 7� <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA#, BILL of LADING/MANIFEST# <br /> 7/1712020 7,8,20 2 0 'CAL000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> �jf')So USED OIL SERVICE C.;-]ARGE I <br /> 3ED ILS <br /> Wo U OIL MI;XED 0" 270 <br /> JOHN 2 0 <br /> _466-4900 BATCH ] TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED'OILS) STATE CODE.221, <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: CA 95358(21MLI-1825CAL00c,'�q <br /> ALTERNATE TSDF: <br /> c,ro j a a sit pa, s Account klarfager: Sarn Read <br /> DRUMS PIU: EMPTY DRUMS:- FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> / <br /> 6i , beIow I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> I,n.g,,e not mixed any of the waste described 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 <br /> complied with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If <br /> the information I have provided about this waste is incorrect <br /> 0#2 1 have not 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 <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste if the information I have provided about this waste is incorrect <br /> 0#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 <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> 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 <br /> (All generators/customers MUST read the following text <br /> 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 <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human fife and the environment. <br /> This individual signing in the space set forth below an behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and d 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 <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with a associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration <br /> est pr <br /> if <br /> e ifest pr m. These fees varybased on Manifest type. Applicable fees will appear on your billing invoice. ff <br /> _VY <br /> C 'come <br /> C tome'Signature "Date Dri6rgi'gnature Date <br /> ol 6� <br /> n 4-M <br />