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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES DBA SERVICES, SERVICE ORDER NO. 1-800-727-2879 N3569942 FOR ACCOUNTING CALL: 0WORLDOIL 562-231-1550 ENVIRONMENTAL SERVICES, H AUTOZONE#5684 7300 CHEVRON WAY,DIXO1-800-727-2879 CA 95620 AUTOZONE PARTS INC P 1339 SOUTH SUTTER STREET 123 SOUTH FRONT STREET E W WW.WORLDOILCORP.COM DEPT 8190 STOCKTON,CA 95206-1450 TRANSPORTER EPA#CAD028277036 MEMPHIS,TN 38103 T (209) 944-9254 (901)495-6500 CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES HU 1 14c3L MIJU I C-1 .mbMiti-H IvilmmiNum 6uHl=UULCU-1li5�L / DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST 4/26/2021 4/21/2021 CAL000148CI51 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL F-'-UUI USED UiL/MIXED OILS- DiY ac BATC1 # TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NOIW-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 ,,,NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ASBURY ENVIRONMENTAL-SERVICES-CERES, 1020 MORGAN RD.,CERES,CA 95358(209)541-1925.CALOW393680 ALTERNATE TSDF: Cross Streets: AccaLmt Manager DRUMS P/U: EMPTY DRUMS: FACILITY; BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below 1 hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) U 111)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 compiled 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 of this waste If 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.I have pruvided proper docornentslion to World Olt Eisvironmomat 9prvices to rebut the presumplion that this waste was mixed with other hazardous waste.I agree to accept the additional aNha/(/grs for Inc disposal or this waste If the Information 1 have provided about this waste Is Incoirecl 'YY3)Thls waale Is from a tank which coliecls waste all from household"dolt-yourself"((MY)attd/o1 conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my DIV/CESOG collection tank Is coley from DIY and/or CESDG sources.I have not mixed this waste oil with any other hazardous waste or waste all from other sources.I agree to accept the additional charges for disposal of this waste If the Information I have provided about this waste Is Incorrect (AIL 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 economically practicable and that I have selected the practicablo method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment Thlc individual tagrsing In the spec*sot form balaw on bohalt 01 cuatemer repfeaentsand NA1tanls that tWnha time the authority to bind cuylamor,lhal the forgoing deaglptlons of wasto and materials are true and acCurble as pnclxaged,matksd,and labeled.sra ready lortransporlatlon Inistowdnneo with applicable elate olid ledofal wgulnitarrs,and that customer shall ablde by she 51usdard Torma and Cend 11lons on the rovarae aide at irrfs Utwee Cider. Snlvlco Orders wish an 071<mleted harandoua wauls rrranlfest(either elle specific or consolidated)are as111{acl lomi EPA Fzignature cover the EPA pass-through fee and administration of Itis gram. These leas vary b3sod ars Man0orol typo.Applicable fees will appear on your billing invoice. rr,, Date CustdTn Signature Date Print Name Print Driver Name"`