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FGA-SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-8007727-2879 FOR ACCOUNTING CALL: g2978246 562-231-1550 S i WORLD OIL ENVIRONMENTAL SERVICES„ H AN!T ONINI ENTERPRISES LLC- L ATHROP73oo CHEVRON WAY,1-800-727-2679 CA 95620 ANTONINI ENTERPRISES 1-1—C- A P 701 DARCY PKWY PO BOX 8466 P WWW.WORLDOILCORRCOM D i A T W ROP r 95331 TRANSPORTER EPA#CAD028277036 STOCKTON, CPL,95215 T (200) 093-3695 (2099) 466-4•900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES rti'v 1000 u /► 01Of �f41V1 1:tAL) SlrlarilllC Z DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 6fa1?U1`� UAL000335703 b )3op�3�9JJ - PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 55-0/T I -= 55 GALLON O/T DRUM (RECONDITIONED) 2 Z JOHN 2119 Ro^6-•-;900 BATCI-I i+ TOTAL CASH REC'D; CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: _ ALTERNATE TSDF• -- Gloss treei'r; Account Manager SMP R60 DRUMS P/U; Z EMPTY DRUMS: FACILITY; BSCF I� irk GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROP IATE } 3Cy l) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following th X Q #1)1 have not mixed any of the waste 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.I have complied with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect Q #21 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 PCBs.I have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other haaardous waste.I agree to accept the addlitonat charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect Q #3)This waste Is from a tank which collects waste oil from household"do-Il-yourself'(DIY)and/or conditionally exempt small quantity gancralor(CESQG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESQG collection tank Is soley from DIY andlar CESQG sources.I have not mixed this waste all with any other hazardous waste or waste all from other sources.l agree to accept the additional charges for disposal of this waste If the Information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human Mand the environment, This Endivtdual signing In the space set forth below on behalf of customer represents and warrants that helshe has the nulhorlty la bit d cuytomar,that the forgoing descriptions of waste and materlale.are true and accurate as packaged,mniked,and labeled,are ready for transportation In accordance with npplicabla ata a and federal regulations,and that customer shall abide by the Standord Terms and Condldons on the reverso side of thls Service Order. Service Orders with an associated hazardous waste munlrest(either site specific or consolidated)are subject to an EPA Fee.Those ee c v the EPA pass-through fee and administration of the aManlfe.t program. These fees va ased an Manifest type Applicable fees will appear on your billing Invoice. C Omer ature Date Driver a ur Date r el 1S Print Name + Print Driver Name