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FOR SERVICE CALL: SERVICE ORDER FORM N0. WOES004•B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA SERVICE ORDER NO. 1w800-727.2879 FOR ACCOUNTING CALL: �� ® ® � � 562w231 -1550 ENVIRONMENTAL SERVICESw s 7300 CHEVRON WAY, DIXON, CA 95620 H o « t i- r7 . r=r 1 .800.727-2879 _ - - ^ .. P / _ 1 (.: � . i ! ' E � �''� �'i � ; ; ;� LD WVWY.WORLDOILCORP.COM ' 'C : 'A''d'. `�ti ��c _Ia wl . I :J, E TRANSPORTER EPA # CAD028277036 r � , D . i ":; i T, 0N . CA 9521 ro T 1�GCKiC;1ti , Ck '37 .' :,, ; 0) 9.51 ; 10i7 209) 951 - 1100 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN 9Y HALIDES stTlartinez DHA 43 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # PART # DESCRIPTION QTY UNIT PRICE OTY P/U TOTAL VVOSC LISED 014_ SERVi E: CHARGE $ 60. 0 (14 `61r;G. 'Jv WO USED OIL I MIXSD 01C.S 350 $0. 00 0 ov $0 . 00 3NYC n TOTAL CASH REC'D: CHECK #. WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 No ? NOR HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE _ .DESIGNATEOTSDF: Ft '+ ?J ,r� r .rv�rf�h1t : �t':al �:= Ry: (` '" � '" � � y iQ"r /yi "t�c (^itt� �?i� �c= n � S ^ Q •�,r+'i4n {��41�i41 1r3 R ^�: :lOf1i91R8+� . . _ ALTERNATE TSDF• Account Manaclpr Sam Read DRUMS P/U : EMPTY DRUMS: FACILITY: 8SC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby oerUly hah ,, J/ (Waste oil generator/customer MUST check ONE of the following three boxes) qi C1 ) 1 have not mixed any of the waste described above whh any other hazardous waste, the total halide content Is LESS than 1 ,000 ppm, and the waste does not contain any PCBsv l have compiled with the requirements of the applicable Caltomla used oil management regulations to determine this 18 true. I agree to accept the additional charges for the disposal of this waste If the Information I haw provided about this waste 1s Incorrect ❑ #21 haw not mixed any of the waste described above with any otter hazardous wasto, the total tw ide content is GREATER than 1,000 ppm, and the waste does not contain any PCs& I have provided charges viided proper d�Uh�waste tit thWorld Oil Envie Inme provided about thus waste eel stn hrptio that this waste was mixed with other hazardous waste. I agree to accept the additional ation (3 #3) This waste is from a tank which collects waste all from household "do4t yourself" (OIY) andtor conditionally exempt small quantity generator (CESOO) sources. To the best of my koowtedge, the only waste il eantal ted In my DfY1 CES charoG ges for dieoposat oI this waste If hfrom ie information II nave provided about this QG sources. I have not was glee nco wade acct th any other hazardous waste or weal. oil from other sources. I agree seoept (All generators/ customers MUST read the following text 1 certify that i have it program in place to reduce the volume and toxicity at waste generated to the degree t have determined to be eaonomlcatiy practi Cable and that 1 have selected the precticabta method of treatment, staroge, or disposal currently available to me which minimizes the present and future threat to human life and the environmanL This IrtdWldusl sig Ing in the space sat forth below an behalf of customer represents and warrants that halshe has the authority to bind customer, that the forgoing desod stoma of walla and a are and accurate as packaged, marked, and labeled, are ready for transportation In accordance with appibahta elate asst federal regulations, and tmt customer aMtl abide by 8rd T and Conditions on the reverse able of this service Order. tan is wt n associated tetoardld (either aspecific oronsolidatd) a � ianEPA � Theta teas cover the EPA passthroughfee and administration very based Applicable n tIng silo r Si nature Date er Signature Date