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FOR SERVICE CALL: SERVICE ORDER FORM NO, WOES004-B (8/16) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBASERVICE ORDER NO. 1 -800-727-2879 N3909514 FOR ACCOUNTING CALL: WORLD OIL.562-231 - 1550 ENVIRONMENTAL SERVICES« 7300 CHEVRON WAY, DIXON, CA 95620 CHANGE OIL NOW H CHANGE OIL NOW 1-600-727-2879 P 720 E. HAMMER LANE. STE G2 720 E HAMMER LANE UNIT G•2 P W W W,W ORLDOILCORP.COM E TRANSPORTER EPA # CAD028277036 STOCKTON, CA 95210 STOCKTON , CA 95210 o (209) 951 -991 2 (209) 951 -9912 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES CHAO9 . HQUIE - CampOS DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # 3/14/2022 CAL000310187 0 2 52 J25 PART # DESCRIPTION roe)Y700 UNIT PRICE CITY PIU TOTAL USED OI SERVICE CHARGE $0.00 $0. 00 WO USED OIL I MIXED OILS $0.00 $0.00 BATCH . TOTAL CASH RECD: CHECK II WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL.JMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: _ DESIGNATED TSDF: WORLO OIL ENVIRONMENTAL SVCS-CERES, 1920 MORGAN RD, CERES, CA 95358 209 541 -18256 CALOOD393660 ALTERNATE TSDF: Account manager, Sam Read_ Cross Streets: PLEASE BRING 30 GALLON FOR_PAPER FILTERS __ ._. DRUMS P/U: EMPTY DRUMS:__ FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I horeby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) ?A) Ihave nol mixed any at theta ste described coca with any other hazardous Wtlsip thetotal halide Content is LESS than 1,606 ppm, and the' waste does not Contain my PCBs Ihave piled with in&requirements of the apptldabla celuam used oil management to determine tVgree his is ue. lato accept the ddlll hal charges for the dtspo8al of this wash it the information I heva provided about this waste is Incorrect .J 021 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than f,66D ppm, and the waste does not Contain any PCBs. I have provided proper documentation to World CII Environmental services to rebut the presumption that this waste Was mixed With other hazardous Waste. l agree to accept the additional charges for the disposal of this waste if the Information I have provided about this Waste Is Incorrect ..1 eel This waste is from a tank which Reflects Waste oil from household "do-11-yourseif" (DINT andfor contlitlonally exempt small quantity generator (c EBCG) sources. To the best of my knowledge, the only waste oil contained In my DIV/ CESOG 0011001011 tank is sally tram DIY andym CESCG sources. I hove not mixed this Waste oil with shy other hazardous waste or waste oil from other sources. l all ree to accept the additional charges for disposal of this wrosteu the Information i have provided about this waste is ihoormof (All generators/ customers MUST read the following text I sandy 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 I have se faced the practicable method att t nt. storage, disposal currently Available to me whichonis ea the Present and Mount threat tno life andoh nvironm 1 This Individual MORRIS In the space sot 1pith bolmv onbehalf of rtrVIOMOt ftPfOSCnIs and werhime that halsh.ohas the authority tbond 041l 01st %he forgoing descriptions of waste nd malonate at¢ 11u0 and aceurpf¢os paCkngod. ma�kyd, and hiy¢Ieil, we to dyf transportation in accordance with applicable state federaland i gelptid S, and that customer shall abide by the standard Term and CoadllionsOA the reverse side of ddaSeMeOd Servo BC derswl thA e ' ed hazard waste m manifest sll specific of eon olldat d) subject io nEPAr :These fees cover the EPA pass through fee and administration of the exleni! t am, 7 wIe s 'a ' based an Manifest type. Applleable fees will appear on your billing olce. C rSlgnffiure Date Krivetrnature Date Print Name Print Driver Name