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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOE5004-B(8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOH 562-231-1550 TING CALL: WORLD OIL IN2792731 ENVIRONMENTAL SERVICES. S 7300 CHEVRON WAY,DIXON,CA95620 I TRACY CHEVROLET-Q&M INC 1-800-727-2879 P 3400 AUTO PLAZA WAY WWW,WORLDOILCORP.coM 3400 AUTO PLAZA WAY P E D TRANSPORTER EPA#CAD028277036 + T TRACY, CA 95304 TRACY, CA 95304 ° (209) 835-4500 (209) 835-4500 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES OAN001 CER-86 �� RICHAEL WALSH DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# i(2212019 CAL000330423 b/&�i�� A S ic PART# DESCRIPTION OTY UNIT PRICE QTY PIU TOTAL PF PAPER FILTERS PER DRUM 3 $85.00 $255,00 55-0ITl1'I 55 GALLON Off DRUM (RECONDITIONED) 3 $52.00 3 $156.00 BATCH A TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION �--� NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CID DE.221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE Cd IE OTHER: ' I"EB 'L RECD DESIGNATED TSDF: ALTERNATE TSDF: -�v -£-T L4-_V11,r`� --"na_Jkead DRUMS P EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby tartly that.- (Waste oil generator/customer MUST check ONE of the following three boxes) 0 e1)1 have not mixed any at 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 compiled with the requIrarnenla of the applicab%Ctd[fantla used oil managemont regulations to determine,this Is true.,f agree to accept the additional charges for the disposal of this waste It the Informallon I have provided about tlft waala In Incorr�rl 0 #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 have provided proper documentation to World DII Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agreeto accept the additional charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 0 s3)This waste Is from a tank which collects waste all from household"do-It-yoursall"(011)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste all contained In my DIY!CESOG collection tank Is soloy from DIY and/or CESOG sources.I have not mixed this waste all with any other hazardous waste or waste oil from other sources.I agree to accept the additional chargee for disposal of this waste 0 the Information 1 have provided about this waste Is Incorrect enerators/customers MUST read the following text I certify that I have a program In reduce f ha votum nd texlclty of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of tma stomga,ar dlaposol cu ndy available to me which minlralzas the,present and future threat to human life and the environment. Thls fndiv[daal a1 In the space set forth betaw behalf of customerrepresenta and worraniz that hefshe ties the authorlty to bindcustomer,Met the forgoingdescrlpttons of yeaete andrnaierlals true and accurate as package Tired,and labeied,are ready for WnapartstlonInareardencswllhappllcoblaslaMand federal regulalfens,and that customer shall abide by the Sit rd Terms and Candlilans on th verse side of this Service Order. Sore Ordera whir an asaaeloted h ous waste manifest(elther site speelflc or cowmlldated)are subl!eat to an EPA Fee. s fees cover the EPA pass-through fee and administration a eotlanlleal program.These f very based on Manllesttype,A pp]Icable I me a wit appear an your bflling Invoice. Custome a Date r ver Signature Data Print Name Print Driver Name