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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOL=UiIi):!•;;f;;�;;;; <br /> 1-NO-727-2879 SERVICE ORDER hfu, <br /> FOR ACCOUNTING CALL: OWORLDOIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES,.. <br /> li 7300 CHEVRON WAY,DIXON,CA 95620 }� <br /> I <br /> PHIL I,IONUL)AfClS 1-800-727-2879 V <br /> o2507 JONES ICU WWW.WORLDOILCORP.COM <br /> o E5C;ALON, CA W320TRANSPORTER EPA#CAD028277036 <br /> (20M 03"150 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY <br /> 251 ;E#t IERAFtCfQ <br /> DATE REQUIRED DATE ENTERED NEXT=DATE CUSTOMER EPA* <br /> DILL of LADINGI MANIi=Ei: - <br /> ?.I25f�E122 <br /> FPEA RT•41 DESCRIPTION''- QTY U�7PRIr07pq <br /> OSLD-5- WASTE OILY SOLIDS•SS�C�L GR <br /> 56.OfTM 55 GALLON'O: /t DRUM(ISC NDIT'IONE©, <br /> EMS EMANIFES"T EPA ME ADMIN SITE SNE-,.I' i< F,jANII �_Sx <br /> CMS : EC'D:_ CHECK�� TOTAL. <br /> WASTE DISPOSAL INFORMATION -- - <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE cow- <br /> - <br /> OTHER: <br /> DESIGNATED TSDF: — <br /> AL.TERNATE'TSDF: <br /> DRUMS BTU: EMPTY DRUMS:_ FACIL,ITY: B$C -- — - I <br /> _ , <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By aNning pew I hereby certify that; <br /> (Waste oil generator/customer MUST check ONE Of tha following three boxes) <br /> 00 r4m i have not mbwd any of the was doegrlbed above with eery trUtlr hlimrdoue was,lhs Fatal hagde oontartt is L-M than 11,1=1 ppta,and dee wame do"not oo+.tnh,any . , <br /> the lirilsd with tM Provided about waste is I tworrgat used oil monagement regulations to drtermina th4 b tnw.I t peep to t dy apgntq>AI chargee far the UlBtpsal of tltYx w:c.u-i, <br /> the Inforntalion I Ilava <br /> Q#21 have not rrrlxad any of the Waste desorlbed above With any other he�rda'm waue.the total hand. <br /> hove 1rrovMled=Horne documentation to World Oil Pmronmontel Bervhm to robtll toe oorrtent la QREA7fitS titan a AO o Iran,urxl tl.e wane ckwe Hol o.x.4dn ntry <br /> ahatgea for nw dlsposaf of thh waste If the tnforrrmticn I hate provided about this waste is irloorreott�this wast!was milled with wF-.r. xm waste.I t.rJ,y,a t�.neoolrt tit.e.Kkliti•N..d <br /> U#3)This waste to from a tock which oollss waste 11)ffUrll hltie"""tto-It tlraell" pt andlov <br /> Icleowledga, II tN�I tmled addiuonal Dlyl 096W oclIO9Uon lark�1 ofln enjoythiin waste DIY�andlor C Ih�+v@e.Ign�s nCt Mu th'. a will'ally)utha hamrclotju wt ctu i r W.&'A,,iii <br /> ce <br /> from otherSW <br /> for <br /> Ilfcrmt,tiolt l have PrOvkW edtlfttt tfas leaps b btoonsoi <br /> (Ail generators/customers MUST read the following text <br /> r certify that I have a pro=mm m pktos to raderedu i alums and tOxtolty oI waste=onerated to tha degise I have delerthinod to Ire eoo"o nosily I~IoalNe and Il.at I have sah)clu.i am. <br /> pmoticaWe method of t►eotmelt4 atolugs,or d mangy avallable to me which minimlaes the <br /> Thta tadivkkml E al In the t„int al>411uh+n tlmsst to himlln 114 and=w arvironmetu. <br /> lH ap spsoo eat fcrdl bllorr on behalf W outdonlor rrlplbealtta and wartnnta that IlNalts Ira!d1e <br /> and matoHab mq true and atxsufaM ae Pa�q"d,markdd,tend labeled too autnaNh to bind auabawr,tlwt tiro foc+guhi=ikwui9 rtiuuu n!w:n:iv <br /> pY free Standard Tema and CondUltrne on the reverse aide of this$ohiFoe gtdedy for trane�ortatloll In 0000rdanoe wlUr aWUmbla y�and ledeml regtdatiolls,anti that cliap,nlur::I cdl.d.i.6 <br /> Sanrloe orders with an associated 11MIdtnw wasp mantivist(flldter alta <br /> of lite ellfanlleot pregrmn.Those fees Vary based an MaaitaetAll apeolfla Or oonblldated)are srlplaot to wn eFA►+ee, 7r�aee lase tF,e CPA twwp_lhr..uph face gxni�rindnl�lr.iLi.q. <br /> type. Appll-OdA0 fess will"Wear on your subject <br /> invotoe. <br /> tomer Sig tura Date <br /> ' 1Qfigt{Ji� fAde <br /> Print Name ” <br /> Print Ewiv r <br />