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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1.800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: N3366206 562-231-1550C�)WORLDOIL ENVIRONMENTAL SERVICES- H ��❑�$-T CY 7300 CHEVRON WAY,DIXON,CA 95620 I 1-800 727-2879 P 2615 W GRANT LINE RD WWW,WORLbOILCORP.COM 2615 W GRANT LINE RD D TRACY CA 95304 TRANSPORTER EPA#CAD028277036 T TRACE`, CR 95304 o (209)832-7436 (208) 632-7436 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES M10655OUTS 11 LEAH PHILLIPS CHE L1LE{0-I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 9 BILL of LADINe1MANIFEST# 9/24/2020 9116/2020 CA L00044CS92 PART# DESCRIPTION ❑TY UNIT PRICE QTY PIU TOTAL. w0sc USED OIL SERVICE CHARGE 1 $95.00 $95.00 wo USED OIL f MIXED OILS 350 $0.00 $0,00 LEAH C LL 925-339-0039 BATCH# TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED 01UMUCED OILS) STATE CODE 221 HON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ASBURY ENVIRONMENTAL SERVICES-CERES,1920 MORGAR1911. CERES,CA 95358(209)641-i825 CAL000393680 ALTERNATE TSDF: Cross Streets: Account manager: Sam Head DRUMS Pill: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below f hereby terrify that! (Waste oil generator/customer MUST check ONE of the following three boxes) 711)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 any PCBs.I have 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 at this waste It the Informatlon I have provided about this waste Is Incorrect 0 021 have not mixed any of the waste described above with any other hazardous waste,the total hallde content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I 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 aerept the additional charges for the disposal of this waste If the Information f have provided about this waste Is Incorrect D03)This waste Is from a tank which collects waste oil from household"do•It-yourself"(0t Y)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESGG collection tank Is sofey from DIY and/or CESGG sources.I have not mixed this waste oil with any other hazardous waste or waste oll from other sources.I agreeto accept the additional charges for disposal of thlswaste if the Information I have provided about this waste Is Incorrect (All generators)customers MUST read the following text 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 cconomieally practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. 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 mater) are true and accurate as packaged,marked,and labeled,ere toady for transperta!]en to aererdenee wlih appllame state and federal regulations,and that customer shall abide by the Stn rd Terms and Condi ns on the reverse side of this Service order. Se Ice❑ e with an assoclaS h rdous waste ma ni fast(tither site specific or consolidated)are subject to an EPA Fee. Theso leen cover the EPA passthrough tee and administration of a efAa i)'. fe t program. The fees ary based on Man[fest type. App[Ic.bis fees wt 11 appear on your hill trig Invoice. C t ure Date river Sig a ure Date Print Name Prin river Name