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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA =N396n 1 .800.727.2879 FOR ACCOUNTING CALL: , ,® OR ® ®IL 562-231 - 1550 WORLD ENVIRONMENTAL SERVICES," g 7300 CHEVRON WAY, DIXON, CA 95620 " CHANGE OIL NOW 1 -800-727-2879 P 720 E. HAMMER LANE, STE G2 WWW.WORLDOILCORP.COM 720 E HAMMER LANE UNIT G2 P E TRANSPORTER EPA # CAD028277036 T STOCKTON,CA 95210 STOCKTON, CA 96210 0 (209) 951 .9912 (209) 951 -8912 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES CHA090 OUTE12 ' ARMANDO SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE MATE CUSTOMER EPA # BILL of LADING/ MANIFEST # 511312022 5/4/2022 CAL000310187 PART # DESCRIPTION QTY UNIT PRICE OTY PIU TOTAL AF ETHYLENE GLYCOL SOLUTIONS 25 $0,00 $0.00 SAT p TOTAL CASH REC'D: CHECK WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE. 133 OTHER: .DESIGNATED TSDF: WORLD 01 . E RO&A pti et ttf"., 501 1Fs i�o2n-eeoe�aerr ILO nEHES,.r° t zea 2fl9.5bt�B25.CJLL0�3$38fD ALTERNATE TSDF: 1^ros,L� * pl FARF RJNG 20CAt I ON FOIi pApFFL FII TFRA Atxount M_ ' Sarteel Read DRUMS P/U:_ EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) 9y signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) :1 of) I have not mixed any of the waste described above with any other hazardous MGM the total halide content is LESS them 1.060 samn, add filwaste ones n the PocontaRAY sAi of Isla whale 11 compiled with the Acquirements of the appocabie Californiaused oil management regpimons to determine this is true, to to acceptddle charges the information t have provided about this waste is incorrect ❑ #21 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 1.0110 ppm, and the waste does not contain any PCBs. I Kaye provided proper doaumentalton to World CII Environmental Se"ums to rebut the presumption that his waste was mixed with other hazardous waste. I agree Io accept the additional charges for the dispoeal of Ihls waste It she information I have provided about this waste Is inoorrOct QA3) This Waste isfrom atankwhich eoil"IswuntcOil IMM ran Scioto do tyousali" lett) sadistcondition llyexemptsmallgbapiitygarchAlor (CESOG) souttes,Tomebeatofmy if= other Aourous. l Agftte Oil l6 Aoascpll eiadditional char gas lot dioa sposal of this.on ons, is weste It thy from fe InformaUo I boyo PAhoded about this WAOOI is Meamsel fSoo jGmece. 1 have not mixod this waste oil with any roar hazardous waste or whsle oil (All generators/ customers MUST read the following text Icertify than have a program in Piece to reduce The vol dre And toxicity of waste generated 10 the degree lhave dounualned 10 be economicallyP ti' able and that l have selected me Practicable slashed of heatmonf, stotaget or disposal currently available to me wfiloh minimizes the Present and figure re throat to human life and the environment. The Individual signing In the sped$04, farm befpr behalf of cushlmer repoento and warrents the l he/$heh the authority to blaq customary that the forgoing descriptions of waste and #tarims are thus and &MOMt6 as inexegod m #etl dfabelod, to ready for tran pm14110l accordance with applicable stale and lassies regulations, an E that customer shall abide by the Standard Terms and CondNona rho shvemis ideof this Gasps Older* 864ew Alsrs wltn aA assdeltod hazardous waste Meatless (either site pecli rc ntl 1 d) ares bl costa an EPA Fee, These lees cover litC EPA pass tmougn fee and etlminisha(Ion Of tits anlfdet Program, f my basad on hl ifosi type. Applicable sees will appear on your bi lingInv oice at Date ignature Date Print - Print Driver Name