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FOR SERVICE CALL: SERVICE ORDER FORM N0.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER N07 1-800-727-2879 FOR ACCOUNTING CALL: GWORLDOIL N3496305 562-231-1550 ENVIRONMENTAL SERVICES, s 7300 CHEVRON WAY,DIXON,CA 95620 H MIDAS -TRACY 1-800-727-2879 P 2615 W GRANT LINE RD WWW.WORLDOILCORP.COM 2615 W GRANT LINE RD E TRANSPORTER EPA#CA6028277036 o TRACY,CA 95304 TRACY, CA 95304 . (209) 832-7436 (209) 832-7436 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES MIM55 f tOUTE 11 LEAH PHILLIPS SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFESTO 2/1112021 2/3/2021 CAL000440892 GZ Z 9, (� PART'# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL WOSC USED OIL SERVICE CHARGE 1 $95.00 $95.00 WO USED OIL t MIXED OILS 250 $0.00 �60 $0.00 LEAH C LL 925-339-0039 BATCH# TOTAL CASH FtEC'D: CHECK"# WASTE DISPOSAL INFORMATION NON-RCRA•HAZARDOUS WASTE, LIQUID(USED OIUMIXEb OiLS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE"GLYCOL SOLUTIONS) ' STATE CODE _...._OTHER... _._ ---- -- - ---- - -- DESIGNATED TSDF: FP&qRQNMDFFA6 SEE GES GPRF!S, 19.19 MORGAN Rig.,GrERES,GA 8N,04090 ALT--�.E�R,N,ATTETSDF: �- Gress StFet : w nt Manager* Cam Rued DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 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 any PCBs.l have compiled with the requirements of the applicable California used oil management regulations to determine this Is true.l agree to accept the additional charges for the disposal of this waste It the information I have provided about this waste is incorrect ❑#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.l 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 charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect ❑if3)Thls.waste Is from a tank which collects waste olbfrom household"do-It-yourself'(DIY)and/or conditionally exempt small quanttty generator(CESOG)sourcoL To the hest o1 my knowledge,the only waste oil contained In my DIY!CESOG cotlectlon tank Is soley from DIY and/or CESOG sources.i have not mixed this waste o0 with any other hazardous waste or waste oil from other sourcm i agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste is Incorrect (All generators/customers MUST read the following text 1 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 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 reprosants and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste and materials are true and accurate as.packagod,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations,and that customer shall abide by the Standard Terms and Conditions on the reverse aide of this Service Order. Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These f cover the EPA pass-through fee and administration of the eManlfestp�roograam. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. 7 i Customer Signature Date Dri Signatur Date Print Name Print ame