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•FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDERN0. 1 .800-727-2879 N3389978 FOR ACCOUNTING CALL: WORLD OIL 562.231 -1550 ENVIRONMENTAL SERViCES , S 7300 CHEVRON WAY, DIXON, CA 95620 H D & H AUTO TECH - DHAO03 1 -800-727-2879 P 720E HAMMER LN STE IOD 720 E HAMMER LN STE iOD P WWW.WORLDOILCORRCOM E TRANSPORTER EPA # CA0028277036 0 STOCKTON, CA 95210 STOCKTON, CA 95210 T (209) 951 A 100 (209) 951 -1100 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES 12 BRANDON boutierrez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # mo� Room 9/22t202O CAL000447335 p� 2 5� Ll3 .� JJ PART # DESCRIPTION QTY UUNIT PRiCE QTY PN TOTAL WOSC USED OIL SERVICE CHARGE 1 $ 160600 $160:00 WO USED OIL / MIXED OILS 110 $0.00 Z $0.00 BAT TOTAL CASH RECD: CHECK # No WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 ON- ;CRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER : DESIGNATED TSDF: ASBURY ENVIRONMENTAL SERtt10ES-CERES i920 MORGAN RD CERES CA 06359 ( Q8)fidt i@25 CALQOSI ALTERNATE TSDF: Cross Streets Account Manager Sam Read DRUMS PN : EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By nine below I hereby certify that (Waste oil generator/customer MUST check ONE of the following three boxes) #i ) 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 PCft 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 It tho information 1 have provided about this waste Is Incorrect 0 121 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 11000 ppm, and the waste dose not contain any PCBs. 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 charges for the disposal of this waste If the Information 1 have provided about this waste Is incorrect o fr2) This waste Is from a tank which collects waste oil from household "do-it-yourself" (om andfor conditionally exempt small quantity generator (CESOG) sources. To the beat of my knowledge, the only waste oft contained In my DIY/ CESOG collection tank is solay from DIY and/or CESOG sourcm i have not mixed this waste all with any other hazardous waste or waste on tram other sources. I agree to eacepi the additional charges for disposal at tis waste it the intormtion I have provided about tris wasto Is Incorrect (All generators/ customers MUST read the following text 1 carUty the 1 have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically practicable and that 1 has saiected the pnufticable method of treatment, storage, of disposal currently avallable to me which minimizes the present and future threat to human lite and the environment. This Individual signing in the space got forth below on behalf of customer represems and warrants that ha/ahe has the authority to bind customer, that the forgoing desptpttorts of waste and materials are in* and accurate as packaged, marked, and labeled, aro ready for transportation in accordance with applicable state and federal regulations, and that customer than abuts by the Slandski Tema and Conditions on the reverse side of this Service Order. W I prognreassociated f abawaste sed no tusnifest(talyp�e rApptspecific eap bbieae wfUsoappearroon areyour billing Invto oices. Fee These fees cover the EPA peawthrough fee and administration 407401 e C o ignaturt3 Date Driver Signature Date w..+_ . _�_ _ O.t .•� f1.t• ..•. itr..we E