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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (4/17) <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL.: N2690715• <br /> 562--231-1550 0 <br /> WORLD OIL <br /> ENVIRONMENTAL, SERVICES,,, <br /> y ANTONINI ENTERPRISES LLC- LATHROP 7300 CHEVRON WAY,DIXON CA 95620 ANTONINi ENTERPRISES LLC-A <br /> 1 701 D'ARCY PKWY 1-800-727-2879 PO BOX 8466 <br /> E LATHRaP, CA 95330 WWW WORLDOILCARP,COM <br /> T LAT ROP, A TRANSPORTER EPA#CA0028277036 STOCKTON, CA 95215 <br /> (209)466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN I UIL18 :EK-M JVHIV 5qulntana <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 4 BILL of LADING/MANIFEST;# <br /> 1 C12i201 s CA1,000385703 0 f Ib "' <br /> PART# DESCRIPTION QTY UNIT PRICE? QQTY P/U TOTAL <br /> OILY S OILY SOL US PER DRUM 2 G <br /> 55-OfTM 55 GALLON O/T DRUM (RECOND)TIONED) 2 <br /> EMS EMANIFEST EPA FEE&ADMIN-SITE SPECIFIC MANIFEST 1 j <br /> JOHN 209-1166-4900 BATCH# <br /> Effective 71112018:Service orders with associated haz waste manifests(site speciffa/consoli ;ed),are subjee to an EPA Fee, pees cover EPA pass- <br /> through fee and administration of the eMartifest program. Fees vary from$4-$10 based an N anifest type, A iplIcables fees Wl I Wr an vour invoice. <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL,INFORMATION ' <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> D�ETSIGNATEDT5DF: _ <br /> AC EiaRNSTbTeR =afst'ManagerTadd Aunt` <br /> DRUMS P/U: L EMPTY DRUMS: FACILITY. 65C I <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE!APPROPRIATE BOX) <br /> by signing below l hereby certify that: BY: <br /> (Waste oil generator/Customer MUST check ONE of the following three boxes i2 33 <br /> C7M1)I havenot mixed any of thewaste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm.and the waste does not contain any PCBs 1 have complied with the requirements of <br /> the app:lrahle California used oil management regulations to determine this Is true.I agree to accept the additional charges for the d lsliosal of this waste it the Info rmation I have provided about this waste is Inconoo <br /> O42 I 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 waste does not contain any PCos.l <br /> have provided proper documentatlon to World 011 Environmental Services to rebut the presumption that thls'wastewas mixed with other hazar'0ous waste,I agree to accept the additional'charges for the dlsposal of this <br /> waste If the Information I have provided about this waste Is Incorrect <br /> I <br /> IIM3)ThlswasteafromatankwhicheAecuwasteoilfromhousehold"do•It•ynvrsetf DIY)and/or conditWnalty eremprsmaiiquanlltygeneralor(CESQG)sources,To the best ofmyknowledge.the only wastabit contained <br /> In my D IY/CFSQG collection tank is sofey from DIY andfor C ES QG sources.l have not tclxed this waste olt with anyoiher hacardous waste o r waite oll from other sources.I agree to accept the additional cloig es f ar disp oral <br /> of this waste if the Information I have provided about this waste is Incorrect <br /> (All generators/customers MUST read the following text and check the associated box,) <br /> A41 if I aura farge quantity genervtor,I certify that I have a program In place to redure the voluroe and toxicity of waste generated to thedegrer.i have determined to be econrornkally pro"Im le and Oat I have <br /> selected ihepncticaWe method of treatment,storage,or dt crsal currently available to me whkh mintm4es the present a:ui future Threat to human life and the environmont;Or,If I ain asmalf quantity generator,I <br /> have made a goad faith effort to mlritmlte my wastegeneration and select the best waste management method that is avaltabieto im Uratitan eiford. <br /> This <br /> indlvldOfsigningInthospaice setforthbelow onbehaIfofCustomerrepresentsaAwarrantsthathelshehasthe 4axhorhytobInd Customee,thattheforgo descriptlonsofwaste andmaterialsareIrueandac? <br /> turate <br /> as packaged,marked and labeled,are ready fortransportatIon In accordance with applicable state and federal regulations,and that Customer sgalIAide,and b and by the StandarclTerms and Conditions on the reverse <br /> IZ <br /> l <br /> side of this Service Order. ,,� <br /> ��/ 6a <br /> ust er Signatu Date Driver Signa* Dat <br /> ,U <br /> Print{game Print Drivers Name <br />