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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA SERVICE ORDER NO. <br /> 1 .800.727-2878 N3766968 <br /> FOR ACOOUNTING CALL: WORLD OIL tis ; 24C5 <br /> 562-231 - 1550 _ <br /> ENVIRONMENTAL SERVICESTM <br /> 7300 CHEVRON WAY , DIXON , CA 95620 <br /> H D & H AUTO TECH I -80 aMw2879 <br /> P 720 E HAMMER LN STE 100 720 E HAMMER LN STE 100 <br /> WWW.WORLDOILCORP.COM <br /> E TRANSPORTER EPA # CAD028277036 STOCKTON , CA 95210 <br /> ° STOCKTON , CA 95210 (209) 851 . 1100 <br /> 0 (209) 951 -1100 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER—1 - BRANDON TAKENBY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER <br /> E44733 BILL of LADING! MANIFEST # <br /> 10118/2021 Q Z 1, 2DJ,7 � <br /> not <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> Wwo to USED 011 SERVI E CHARGE 1 g ,0 5.00 <br /> TWO USED OIL / MIXED OILS 30 $0 . 0Q 03 $0. 00 <br /> 4 <br /> TOTAL <br /> BAT # _ PAGED DRIVE <br /> CASH REC'D: CHECK #_ <br /> WASTE DISPOSAL INFORMATION <br /> OWRCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE 221 <br /> NON•RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> 'OTHER; 1520 MORGAN R0 . CERES, CA 65358 209 541 .1825, G4L000393660 <br /> XDESIGNATED TSDF: WORLO OIL ENVIRONMENTAL SVCS-CERES, <br /> ALTERNATE TSDF: Accouht Manager: Sam Read <br /> Cross Streets: <br /> DRUMS PIU : . EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> 701 ) <br /> gning below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> [ have not mixed any of the waste described above with any other hazardous waste, the total halide content Is LESS than 1 ,090 ppm,the additionalto for ts not he Bain any PC1394 of this I have <br /> ate ft <br /> i compiled with the requirements of the applicable California used ell management reguladona to determine this is true. l agree to acceptr8 <br /> the information I have provided about this waste Is InCOrrect <br /> U 021 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 1 ,060 ppm, and the waste does not contain any PCBs. l <br /> I 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 <br /> charges for the disposal of this waste If the information I have provided about this waste is Incorrect <br /> U 03) This waste Is from a tank which collects waste oil from household "do-it•yourself" pyo andlor conditionally exempt small quantity generator (CESOO) sources. To the beet of my <br /> knowledge, the only wsata all contained In m DIW chs sea for disposal of n soisy <br /> waaro N heYlnt dlor Clop OG so provided I have <br /> about this �atathis <br /> la Incorrect <br /> waste <br /> oil <br /> with any other hazardous waste or waste Oil <br /> from other sources. I agreo to accept <br /> (All generators/ customers MUST read the following text <br /> I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determined to he economically practicable and that I have selected the <br /> practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human lite and the environment g <br /> of <br /> te <br /> This individual aigning In the space sat forth below, marked,behalf <br /> of <br /> labeled cis reed a is and <br /> tts hat he/she <br /> has <br /> w with applicable e=ats and federal regulattoca Bind tt descriptions sonir shall abide <br /> and matulals sre Wuss and &=rate as packaged, <br /> by the Standard Terms and Conditions on the reverse side of this Service Orde Y <br /> S ry d� with an associated hazardous waste mentfest (either site'I�le teor es consolidated) <br /> a lid a are <br /> our bject to an lea Fes � cover the EPA passthrough tea and administration <br /> ew fess vary based on Manifest type. App PPa y �¢ <br /> Chi V <br /> st Signature Date erSignature <br /> ` Date <br />