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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA rM37865()!08n <br /> 1 -800.727.2679 <br /> FOR ACCOUNTING CALL: ® RL ® ® IL <br /> 562-231 -1550 •'\•/ <br /> ENVIRONMENTAL SERVICESto <br /> s 7300 CHEVRON WAY, DIXON, CA 95620 <br /> HCHANGE OIL NOW 1 -800-727-2879 <br /> 1 720 E HAMMER LANE UNIT G•2 <br /> P 720 E. HAMMER LANE, STE G2 WWW.WORLDOILCORP.COM <br /> P <br /> E TRANSPORTER EPA # CA0028277036 STOCKTON, CA 95210 <br /> D STOCKTON, CA 95210 <br /> o ;209) 951 -9942 (209y951 -9912 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> CHA090 UTE 124 ARMANDO shinoiosa <br /> DATE REQUIRED DATE ENTERED NEXT SERVI E DA E CUSTOMER EPA # BILL oT LADING/ MANIFEST # <br /> 2/1 /2020 CAL000310187 T <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> WOSC USED OIL SERVICE UP 1ARGC- 1 $0. 00 $0,00 <br /> WO USED OIL / MIXED OILS 700 $0. 00 q3 $0 . 00 <br /> BATCH ITOTAL <br /> CASH RECD: CHECK # <br /> WASTE DISPOSAL INFORMATION <br /> 'NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE 221 <br /> NOWRCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE,_. <br /> OTHER: .—. 111 <br /> DESIGNATED TSDF: WORLD OIL >'NVIRONMENTAL SVCS CERES 1920 MORGAN RD CERES CA 45358 2C9 54.'- 1825. G'AL0003936 <br /> ALTERNATE TSDF: Account Manager, Sem Read <br /> Cross Sheets' PLEASE BRING 30 GALLON FOR PAPER FILTER4 <br /> DRUMS PIU : EMPTY DRUMS: FACILITY: BSC <br /> f3ifining <br /> GENERATOR-:WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE . BOX) <br /> below i h@t011 cedi lan: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ll have not mixedanyot Ura Wastadaatibed obi" WRh anyothpr hrt:xdou wast , IIA I )at hande< nl " LESS hien i Oaa PP . aadh est dons not he dlsln any <br /> ICinis waste 11 <br /> compiled with the regulrements of the applicable CAHIOMa Used oh management regulations to determine this is true. Ia to accept the additional Charges or pose o <br /> the InlormBtion I have provided about this Marc is Incorrect <br /> :1 021 have not mixed any of the waste described above with any other hazardous waste, the [Dial halide content is GREATER than 1 ,go0 ppm, and the waste does not contain any PC Its, I <br /> 1iprovided proper documentation <br /> otherd !manonihavepEnvironmental <br /> Services <br /> tot this Wasteisumpti n tthat this waste was mixed whh other hazardous waste. I agree to swept the additional <br /> charges the dippose oftiIf <br /> 10 09) This More Is from a lank Which collects waste 01) from houselmd "duit•yoursell" (DIV) andlor conditionally exempt small quantity generator tCESO6) sources. To the best of my <br /> knowledge, the only waste oil contained in my DW CESDC collection lank Is soley isweatemca it lnf0rmaCESOGsouon I have res. I have <br /> not <br /> bout mixed <br /> dB i waste <br /> sorreall with any other hazardous Waste ar Waste Oil <br /> from other sources, l agree to accept the Additional charges peso <br /> ct <br /> (All generators/ customers MUST read the following text <br /> I coal 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 l have selected the <br /> Practicable method of treatment, storage, or disposal currently available to me which mlAimizes the present and future threat to human life and the environment. <br /> This Individual signing In the space ser forth below on behalf of customer represents and Warrants that hDA110 has the authority to bind customer, that the forgoing descriptions of waste <br /> and materials ere kin andhe space se packaged, marked, and t customer <br /> ar¢ toadylot a nsponstion in accordance with applicable state and federal Iegaiailoap. and Ina) customer shall abide <br /> by the 9ta hdaed Terms and Conditions on the reverse side of this Service Oickh, <br /> Service Orders with an 0111 tafa� hazardous waste-mshileal ionizer site <br /> 1pcificor conalidated) are subihlnt tin an EPEPA <br /> Foe. le¢s <ov¢r the EPA passghrough leeand administrallon <br /> of the e f - f . These nee very M"Ace pn MaMyeal 1Ypc AtPO toe PPear on Your 9 — ,x <br /> � G nature Date viz Iver gnature Date <br /> I ' <br /> Print Name r Print rive�r=Na/m=e <br />