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FOR SERVICE CALL: SERVICE.ORDER FORM NO.WOES004-8(8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-soo-7a7-2s7s FOR ACCOUNTING CALL: "z� N324 725 i WORLD OIL ENVIRONMENTAL SERVICESar H 7300 CHEVRON WAY,DIXON,CA 95820 MIDAS -GRAN LINE RD 1-800.72T-2879 P 2615 W GRANT UNE R>D WWW.wORLDOILcoRP.cvM 261 W GRANT .INE Rt1 oTRANSPORTER EPA#CAD028277038 T !ICAC`{,C:I1 95304 TR/§CY, CA 95W4 0 (269)832-7436 (209) S32-7436 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES 1rif�3 10UTE 11(1 LEAH PHILLIPS SCHEDIULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE. CUSTOMER EPA# BILL of LADING/MANIFEST# 4/17/20211 41'312020 CAL000440S92 � � - r) PART# DESCRIPTION CITY UNIT PRICE OTY PIU TOTAL WOSC USED OIL SERVICE CHARGE 1 $45.00 $45.00 WO LSED OIL/WXED OILS 4.50 $0.00 130.00 LEAH C LL 925-339-Wag BATCH TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUlMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODS OTHER: DESIGNATED TSDF: ASREJRYF,%AnP.QLgMF1VTA# P`iF.RtItC>~-,CFreFS itYJO_'1R_+' RCz4 f FZ`'(„G'r RF "A A_5�r_r91a_t1G15d1_�e}a, ft.Gi nrnTG ..: ALTERNATE TSDF: C;rot-� rrPwi—,7 _ _ _ Account khirtar4 �! DRUMS Pill: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRI B❑ )R 2 2 2o2o By slgn[ng below I hereby certify that: (Waste ail generator/customer MUST check ONE of the following thr as 41)1 have 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 an compiled 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 disposalof this 0111 the Information I have provided about this waste Is Incorrect ❑#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 riot contain any PCBs.I have provided proper documentation to World Oil Environmental Servlees to rebut the presumptlon that thIs waste was mixed with olhur tlazarduus wash.I agree fv accept the additivnal charges for the disp Mal of this waste if the Inronnatlon I have provided about this waste Is Incorrect ❑#3)This waste Is from a tank which collects waste oil from household"do-ItIouirself"(DIY)andlor conditionally exempt small quantity generator(CES❑G)sources.To the best of my knowledge,the only waste oil contained in my DIY!CESOG collection tank Is sole/from Dly and/or 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 dlsposal of this waste If the In tormatlon 1 have provided abdutthIs Waste Is Incorrect - (Ail generators/customers MUST read the following text I certify f hat I have a program In pia reduce the volume and toxicity of waste generated to the degree I have determined to be eco nomlcally practicable and that I have selected the practicable method of lreatmen . orage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. This Ind Met uai signing i e space set forth below on behalf of customer represents and warrants that helshe has the authority to bind customer,that the forgoing descriptions of waste and male rlals are true d accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulet fens.and that customer shall abide by the Standard Ter and Conditions on the reverse slde of this Service Order. Service Orders h an associated haze ous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These} s cover the EPA pass-through fee and administration of the eMan[fe rogram.T ese fees cry setl on Pnanifesttype. Applicable fees well appear an your b�lling Involee. Customer D to Driver Si7 ate �R Print Name L/ Print D ' r Name