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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-13 (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1 -800.727-2879 <br /> FOR ACCOUNTING CALL: N3646901 <br /> 562-231-1560 WORLD OIL <br /> ENVIRONMENTAL SERVICESaa <br /> H CHANGE OIL NOW 7300 CHEVRON WAY, DIXON, CA 95620 <br /> i 1-800-727.2879 <br /> P 720 E, HAMMER LANE, STE G2 720 E HAMMER LANE UNIT G-2 <br /> P W W W.WORLDOILCORP.COM <br /> STOCKTON, CA 95210 TRANSPORTER EPA # CAD028277036 STOCKTON, CA 95210 <br /> 0 (209) 9514912 (209) 9514912 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # : TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> cam os <br /> DATE REQUIRED DATEENTERE '_ NEXT SERVICE DA `CUSTOMER.EPA # BILL o4 LADING/ MANIFEST # <br /> 6/ 8 2021 CAL000310187 <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> U9GD OIL SER E CHARGE $0, 0400 <br /> WO USED OIL / MIXED OILS 65 ! $0.00 / $0,00 <br /> 9ATO 1 * <br /> : TOTAL <br /> CASH RECD: CHECK # <br /> WASTE DISPOSAL INFORMATION <br /> ON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 <br /> rI)A <br /> ON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_. <br /> THER: <br /> ESIGNATen Tsor.i WORLD OIL ENVIRONMWAL'SVOS-ORES 't920 MORGANRO 1OERE <br /> S S0A 08355209641 1626 CA1,tl00303680 <br /> LTERNATETSDF: . <br /> Cross Streets• PLEASE BRING 30 QALLON FOR PAPER FILTERS Account Manager Sam Read <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: @SG <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> pyo I gb low i literacydify that: <br /> (Waste oil generator/oustomer MUST check ONE of the following throe boxes) <br /> at) ih notmixed any of diowaslo described eboVdw'ilh any DjllerhabsYdads 4yasle, the total battle cdolont is LESS then 1000 ppm, sod Me Weds does notcaalkin any Mass l have <br /> compiledwith The requirements of the applicable California used all management regulations to determine this to (me, I agree to accept the additional charges for the disposal of this waslo If <br /> the Informallon 1 have provided about this waela is Incorrect <br /> ❑ 921 have not mixed any of the waste described above with any other hazardous waste, the total halide content Is GREATER than 1)000 ppm, and the wasio docs not contain any PCBs- I <br /> have provided proper documentation to World CII Environmental Swrvioae to rebut the presumption that this waste was mixed with other hazardous waste, t agree to accept the additional <br /> Charges for the disposal of this waste It the Information I have provided about this waste Is Inoonaot <br /> ❑ d3) This waste Is from a lank which collects Waste all from household "do-IlyoumalP' CDM endfor conditionally exempt small qua lltygenerator (CESOO) sources. To the host of my <br /> knowledge, the only waste all maddned In my DIyy rtmo collection lank Is delay from DlY and/or Ceson sources. ) have not mixed (his waste oil with any other hazardous waste or waste all <br /> from other eamoos. l agree to accept the additional charges for disposal at this waste It the Information I have provided about this waste Is incorrect <br /> (All generators/ customers MUST read the following text <br /> I Cedlfy Wal I have a program In place to reduce the volume and toxicity of waste generated to the dogma I have delerminod to be economically pmelkabie and that I have selected the <br /> Practicable m lTud of treatment, Storage, or disposal outrondy available to me which minimizes the present and future threat to hued a)Ife and tho environmenh <br /> Thisind(v((�Q(oeteignlneln tfioapapOsolfp hhalcwgn bahallg q(�¢lOrgarippmedia add woodland That he/Ahs f,ae lho authority to bind 0011 m,thatthe Imaging dpaedpllons of waste <br /> nd malfa�� good <br /> d from <br /> 1110ala pas gad of&Aad, sno Vakd, alartltf farlrydppddaeOn (naeGbtdandswahmeallcabiostatdapola 00112m,that <br /> r6guldd0im,snd Its moRomarshall abide <br /> by the dardTarms anU,aan (UgnsOn Sho mSpraosldo of Ul epry 1.Wf'd f - - - - <br /> SerieSerieoGlderdWilli on consisted hodando awall#M itm(uhhoemle appoVi00r consoildplotp am sgqBeal 1pu dR EPA Fee. i o fees cover the EPA P"s-through loo end adminiefrallan <br /> at <br /> s <br /> mar. aria eadVary based on f1snllem typo, Appleable fogsWlll appeared yearb�lgd$Invaute. <br /> i <br /> 'C s iTerSi nature ' �} , date verSlgnatuo � Date - <br /> zm <br /> Prt Name Print Driver Name <br />