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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-6(8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> ' i�33'13�r�3 <br /> FOR ACCOUNTING CALL; WORLD OIL <br /> 552-231-1550 <br /> ENVIRONMENTAL SERVICES- <br /> S 7300 CHPVRON WAY,DIXON,CA 95620 <br /> H 1r1€DDS- -Re%CY 1.800-727.2879 <br /> P .?�ii+j lflf GR.�!�!?!';,1 ,,.!� 2615 <br /> 1tV GRA)JNtT LINE RD <br /> P WWW.WORLDOILCORP.COM <br /> b ..�ui0. TRANSPORTER EPA#CAD0282T7036 <br /> 7R/4CY.CI~, <br /> T ��� TRI ICY, CA 5304 <br /> (2091, 632-74361 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 'IOUTE 11111 LEAH PHILLIPS SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINGI MANIFEST# <br /> g tre.02O 712.9/2020 I C CAL,00041402 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> W03C JSC!L ERVICE CHh1RGE <br /> L'LfO <br /> US=-D C!L! MIXED 011-IS 50.00 $0.00 <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NOH-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: ASEUR)'ENVirRONMEN TAL SERVICES-CERES, 1920 MORGAN RD.,CERES CF,95358(209)541-1825,CAL0003936t30 <br /> ALTERNATE TSDF: <br /> Cross&reeiy Accaunt Manager:Sam Read <br /> DRUMS PIU: EMP"T"Y DRUMS-. FACILITY: BBC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby dentty That: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> &111)I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste does not contain any PCBs-I have <br /> complied with the requirements of the appilcable Callfomla used all management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If <br /> the Infarmation I have provided about this waste Is Incorrect <br /> ❑#21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste_I agree to accept the additlonai <br /> charges for the disposal of this waste if the information I have provided about this waste Is incorrect <br /> ❑ <br /> 43)This waste Is from a tank which collects waste all from household"do-It-yourself'(131Y)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIW CE$GQ collection tank is wey from DIY and/or CESQG sources.I have net mixed this waste off with any other hazardous waste or waste oil <br /> from other sources.1 agree to accept the additional charges for disposal of ibis waste If the Imormatlon I have provided,about this waste Is Incorrect <br /> r <br /> (ATI generators/customers MUST read the fallowing text <br /> I.certify that(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,ardisposal currently available to me which minimizes the present and future threat 10 human life and the environment. <br /> This Individual slggning In the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgolaq descrlpilons of waste <br /> and materials are. rue and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customershall abide <br /> by.the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are suhlect to an EPA Fee. These fees aver the EPA pass through fee and administration <br /> of the ehlanifest program. These fees vary based on Manifest type. Applicable fees wlll appearon your h/fine invoice. <br /> Gdustnmer 9i9 nature to Dirt i nLturer mate <br /> f <br /> Print Name Print er Name <br />