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FOR SERVICE CALL: SERVICE ORDER FORM N0. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1 -800-727-2879 y 3949029 <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562.231 -1550 <br /> ENVIRONMENTAL SERVICESN <br /> 7300 CHEVRON WAY, DIXON, CA 95620 CHANGE OIL NOW <br /> r G ANGE Ol : NOW 1 .600-727-2679 720 E HAMMER LANE UNIT G-2 <br /> P 72C 2 �IAUIMER LANE, STE G2 WWWWORLDOILCORP.COM <br /> P TRANSPORTER EPA # CAD028271036 STOCICCON, CA 95210 <br /> STOCK, CN1CA :952i0 ;2091151 -9912 <br /> T (209) 951 99"2 <br /> CUSTOMER If PURCHASE ORDER If ROUTE # TRUCK 8 CONTACT NAME ORDER SAKEN BY HALIDES <br /> to 2019 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER.EPA # BILL of LADING/ MANIFEST # <br /> 4/22/2022 CAL 00310187 0 Z L } 101 y If J /( <br /> PART # DESCRIPTION OTY UNIT PRICE CITY P/U TOTAL <br /> x:95 00 <br /> PF PAPER FILTERS PER bRUM 1 885.00 i SC.00 <br /> OFDR OIL FILTER DRUM REPT ACEIUf N' - NO CHARGE O.00 <br /> 6ATC11 TOTAL <br /> CASH RECD: CHECK #. <br /> WASTE DISPOSAL INFORMATION STATE CODE 221 <br /> NON•RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) <br /> NON•RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) <br /> STATE CODE_ <br /> OTHER:_ I�nya�itn unonanntic AE.��Q3, n rn.�!_I �a acetal acTlr• ail raac / r•Faatzt <br /> DESIGNATED TSDF: YES MANAGEM str -C $500 US i9l"--AY-261 YUM6u 4Z 85365 -- <br /> ALTERNATE TSDF: — - o dAL7cgen 'rca Account Mucet7Br, Sam Read <br /> Pt aAAP RRIi G ..30 GGA LO?LFC <br /> DRUMS P . : EMPTY DRUMS: FACILITY:. BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> %Jai)t have not mixed my at the maw described above- with any other hazardous waste4 the total halide content is LESS than 1.000 PPM, end the waste dem not conuin any PCAs, l have <br /> complied with the fagWyemomt of the Applicable ripillmilla used oil management regulations to delerrnlne the is true, Iagree to nostril the Additional changes for the disposal of this waste if <br /> the Intetinallon I bass provided abadl ihls waste is hme rrecl <br /> J g2lhava not mfxedanyof the wasMdesctltlatl above with my Olhtthazardous was/ the total halide content is GHaAyeR to an 1,000 pp and the waste does nptaalltam any PGas. i <br /> have 1 hprovidedenl mixeer d any <br /> of the waste esetd od AinBoomronmeniai Service to tell the 1 eaurrgllon that (his waste was mixed with other hazardous waste. I agree t0 accept the.additional <br /> charges for the disposal of this waste It theIniomeffon l have ptayldod bout this Waahe i9 fncOrreci <br /> from 0 tank which 0011mis. Waste all Item household do-d•lomrseIr (Di Y) sadist cane llOntlY attempt Il lido - dlygenerator (CESDG) sourom To the WAR of my <br /> Jk0) This waste f6 <br /> knowledge, tpe only waste all abnlalnod In my PlY10ESOG foilaciion tank to alley from olY mWoi CPSQO sour Ihav not Waold 011 with any other hazardous waste or waste oil <br /> Itemolder, the Only Iasteall eooaptahae my rival ,m ass lot disposal of this waste if the information t have provided About this waste is Incorrect <br /> (All generators/ customers MUST read the following text <br /> I cadity that I have a program In place to reduce the volume and toxicity of %sale generated to the degree I have determined to be economically practicable and that 1 have selected the <br /> practicable method oftreating1, storage, disposal currently available to me Whichminimizes thpresent and future ument to human life andth nviron nt.forgoing <br /> f waste <br /> This individual the space sat ! dh halOw.onb nail f customer dptes is and warrantsthataccordance with <br /> the authority <br /> slto laat and i deral od customer, lhat the MQUIS9onsg,ai ilialevil mellorm rshall abide <br /> and mafedeb Alt true andacoamta as peak god metKed dtabdt¢d ata roadyt ria po'rl 0 maccoMence wan App ca <br /> by theStandardTOM S ad Centlllbli the e verse fid t thist nflca O d r <br /> Servsce a order stwith associated <br /> ha rya don hi fest (type r site Specificbis <br /> fees oon Appearacd) re owtotlnig lnyelee.A Fee, <br /> . These cover ine EPA pass ihraugh fee and administration <br /> of grog Z <br /> i <br /> a St nature Date <br /> Date <br /> Customer Signature <br /> Print Name <br /> Print Driver Name <br />