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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8116) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: i�,WORLD �� I 562-231-1550 f ENVIRONMENTAL SERVICES,, S 7300 CHEVRON WAY,DIXON,CA 95620 P SEARS A/C 6791 1-sae 727-2s7s QUEST RESOURCE MGIVIT-SEAI P5110 PACIFIC AVE WWW.WORLDOILCORP.COM 6175 MAIN STREET, SUITE 420 E TRANSPORTER EPA#CAD028277036 T STOCKTON, CA 95207 FRISCO, TX 73034 (209) 475-6528 (972) 464-0004 CUSTOMER# PURCHASE ORDER# ROUTE# ' TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES SEA633 771730 CER-86 Z 70/,,-/ CINDY avelazquez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 4115/2019 CAD982343253 /,.7 3/zgs-�r, PART# DESCRIPTION QTY UNIT PRICE OTY P/U TOTAL EMS EMANIFES T EPA FEE St.ADMIN-SITE SPECIFIC MANIFES 1 � PF PAPER FILTERS PER DRUM 1 / 55-0/Tiv 55 GALLON OIl'DRUM (RECONDITIONED) 1 REF#7T'730 BATCH# TOTAL CASH REC'D: CHECK# f WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: DRUMS PIIl: 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) a1)1 have not mixed any of the waste described above with any other hazardous waste,the total hallde content Is LESS then 1,000 ppm,and the waste does not contain any PCBs.l have complied with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the addltlonal charges ferthe disposal of this waste It the Information I have provided about this waste Is Incorrect Q #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 thFBY: have provided proper documentation to World 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous wcharges for the disposal of this waste If the Information I have provided about this Waste Is incorrect1nnr�� IIf0 a3)This waste is from a tank which coltects waste oil Itam household"da-It-youraor PIY)andlor conditionally exempt small quwtilty generator( d�s.�vtf31al yknowledge,the onlywasteall contalnad in my nlY1CESQG roilectinn tank is saley from olYand/orCESOG sources.I have nat mixed thlswaata ailwhazardaaswaste orwasteoll from other sources,i agree to accept the addillonal charges for disposal of thlawasia it the Information I have provided about this waste Is Incarreci(All generators/customers MUST read the following text """ I cerilfy that i havo a program In place to reduce the oltrme and toxicity of waste generated to the degree i have determined to be economically pre cllcahlo and that I have selected the pmcilcablemelhad of trentrrtent,store apesal cur tly available to me which minimizes the present and future threalto human life and the environment. Tlrls Individual signing In the set forth haloes en f of oustamer repreacnts and worrants that Wshs has the authorltyto bind customer,that the forgoing dascrlptlons of waste and materials are iruo an curate as patkaged,mark ,and labeled.aro ready far transportation In accordance wlih applicable stela end federal regulations,and that customer shall abide by the 5t�ndard 7arm nd Cartaitlona on fha rave de of this Service Order. Service Orders an a aced heasrda axle manlft(either elieap.elite or conislldatrsd]are subject to an EPA Fee.Ther, cover the EPA pass-through fee and administration of the Mani t pro hese[ y basad on Manifest type. Appllts�le fees will appear on your billing lmoleo. 22 Customer Signature Date river Signature Date *t-m ?w r �1� �r � Print Name Print Driver Name