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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA t SERVICE ORDER N0. <br /> 1 .800-727-2879 <br /> FOR ACCOUNTINGCALL: WORLD OIL -. . N3758287 <br /> 1 -1550 CQ <br /> ENVIRONMENTAL SERVICES ,„ <br /> s 7300 CHEVRON WAY, DIXON, CA 95620 <br /> i' CHANGE OiL NOW 1600,727-2879 <br /> P 720 E. HAMMER LANE, STE G2 WWW.WORLDOILCORP.COM 720 E HAMMER LANE UNIT G-2 <br /> r TRANSPORTER EPA If CAD028277036 <br /> 0 <br /> STOCKTON ,CA 95210 STOCKTON, CA 95210 <br /> (209) 951.9912 (209) 951 .9912 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY F HALIDES <br /> CHAO90 ROUTE 1 4 ARMANDO SCHEDULED-I <br /> DATE REQUIRED DATE ENTERED _ NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # <br /> 10/151202 1016/2021 CAL00031016 W ©3,e L` 40o JV (� <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> AF ETHYLENE GLYCOL SOLUTIONS 1 $0. 00 $0.00 <br /> BAT, H # TOTAL <br /> CASHREC'D: CHECK #_, . ,;: :.. .,::.: <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 <br /> XNON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE,_ 133 <br /> OTHER : <br /> X ESIGNATED TSDFi _ _ WORLB9I�ENWVtR9N?!f£NTAL3V �.• -1g0-MfiR9ANFb'GCr,'-6A-95§58-208-5"'"102;'�Ar800393600 <br /> ALTERNATE TSDF ; -- <br /> firossstreets: PLEAS✓ BRihtB 36 GAELLBN F6f2 RAFg I}+EIkTERS "wBunt Ni@na tB &ora 1teBd <br /> DRUMS PIU: EMPTY DRUMS: - FACILITY; . -. . BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby earthy that! <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Jet) Ihave notmixedanyoftheWombdescribedAgent With anyother hazardous wagle, thetotal tender contenttoLESS than I,gdbfirm, and the waste does not contain any Kilo, Ihave <br /> compiled with the 4equirameNs of the OPPl(cabi8C8blolnla used oil management regulations to determination Is out. 1091110 to Accept Ilia;additional charges for the dlspOyRl Ofthis waste 11 <br /> the Information i have provided about this Woods (a Incorrect <br /> J a2 I have not mixed any at the waste dasedbed above With say Diner hazardous Waste, theOist Intuit content Is GREATER than 1 ,000 prim, and the waste does not contain any POBs. I <br /> have Provided Paper qac Mentation to World Oil EnvItaniftOM01 Services to rebut the presumption that this waste was mixed with other hazardous waste l agree to zccOPi the additional <br /> charges for Its dieposed of this Waste if the Information t have Provided about his waste Is Incorrect <br /> j43) This waste is train a (ankwiteds concede Virgin oil ham household dalhyoursoly, i0xv) manor condid0nalty exempt soon4uamany !lens41 (CESOG) saturates- To the hest I my <br /> knowledge the only'waited op contained In cry,Girl c9soR'gallootion Exams later from ply addror oRsocf goings. In a m tizol this Waste 11 with any Other balnudous wpAle or waste all <br /> from other Inmacea;l agreeto aaoapt Iho sddhiadal charges for,naposplot thig na she n the Information l have provided about lids wesig is Incorrect <br /> (All generators/ customers MUST read the following text <br /> I cazllfy that l he" a.Wpgram In pint to reducethe vantage bad toxicity of Waste garlanded! to the ogee lhave dchurntnodt be aconOnduatypracticable and that l have selected me <br /> practicable method Of 11mumgnl, hrOntilei of disposal c ra tly tolmlilble to me which Minimizes the Pfese 1 and 411 4114 throat iG humaM1 Zile and theev)rOnme it. <br /> This Individual signing in the spate so; fodh Celoty M bohir" (Avatgme apfs lh <br /> os nts and Warrppnngiha/ hgh the auth hyt bind gualomq that the forgoing descriptions of waste <br /> nom larrala me lids oadaoN@ipq¢ pa5kagad;marketl, and {ahelCd;are ready lotiranspPr1af11 in a¢dgtdnnge with Applicable slol8 and federal raodlalidrw, an dlalaaslomor shall ahltlo <br /> by the standard TMms and Gonna ns onlnC rBvet#OAide of this Serves order, <br /> SeOName <br /> an ass orated hazardous wa ism 1st ( nom alta 9ppooHio or aodsalklatod) ere Aide11 lis an EPA so fees covet the EPA pass-Ihmugh lee and atlminlsbatiOn <br /> of them "a hies varyiguivin hianlitut type. App110able leas Witt apPegfanydur b((1nng Invoice <br /> 4iV <br /> i Ca ure Date r 51gnture' Date <br /> PPrint Driver Name <br />