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FOR•SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B,(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDERtNO. <br /> .1-800-727-2879 <br /> FOR ACCOUNTING CALL: (-:"`,WORLD <br /> D�L Na180G6G <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES- <br /> 00 CHEVRON WAY,DIXON,CA 95620 <br /> ANTONIN! ENTERPRISES LLC- LATHROP731-800-727-2879 AN T ONINI ENTERPRISES LLC-ANTG <br /> P 701 D'ARCY PKWY WWW.WORLDOILCOFIP.COM PO BOX 8468 <br /> TLATHRZO C"A 95336 TRANSPORTER EPA#CAD028277036 SETOCKTON, CA 9! 215 <br /> T <br /> 0 (209) 993-8695 (209) 4664900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT606 CER-86 ;W 2 JOHNI SAM READ stnertinez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 2/2812020 CAL000365703 <br /> PART# DESCRIPTION QTY UNIT PRICE OTY P/U TOTAL <br /> Ptm PAPER FILTERS PER DRUM 2 <br /> OFR OIL FILTER.DRUM REPLAC'ENtiENT NO CHARGE 2 <br /> JOHN 2C'�-466-4900 BATCH#_ <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NOWRCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODs; <br /> OTHER:_ nlrtint.tarlaa l 1ar4pinr-tr fc tnut r- :I 1l_I /nII ac rlr :Il roc rI�EMl_a r�yTr-„dam,V:;7DESIGNATED TSDF: GhklIV $S.Yi1Th1lA AZ 85 55. -- <br /> ALTERNATE TSDF: <br /> Cross Streets: Account�Gartaffer:Sam f.esd <br /> DRUMS P/U:_ �­ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROp IATI=�607{) o <br /> By signing below I hereby certify that: Ry: <br /> : <br /> (Waste oil generator/customer MUST check ONE of the following three <br /> #1)I have not mixed any of the waste descilbed above wlth any other harnRious waste,She totaf halldeconteni Is LESS than 1,000 ppm,and the waste dors not contain any PCBs.I have <br /> compiled with the requirements of the applicable Callforn fa used oll management regulations to dolermdne this is true.I agree'to accept the additional charges for the disposal of this waste If <br /> the Information I have provided about this waste Is.lncorrect <br /> 0 #21 have no$mixed any of the waste described above with any othgrt azardous waste,the total halide content Is GREATER then 1,000 ppm,end the waste does not contain any PCBs.I <br /> have provided proper documenfalfon to World Oil Environmental Servlaas to rebut the,presumpllon that this waste was mixed with other 112zardous waste.I agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste is Incorrect <br /> [] *3)This waate Is from it tank which collcals waste all from household"do-if-yourseff"(DIV)andlar condltlonally exempt small quantity generator(CESOG)seurees.To the best of my <br /> knowledge,the only waste all contained In my DIVI CESOG collection tank is sofey lrem MY an"r CESOr.sources.I have r;al mixed this waste all with any other hazardous waste or waste oil <br /> from other sources.I agree to accept.lhe arldillonat charges for disposal of Mils waste If the Information I have provided about this waste Is Incorrect <br /> (All generators/customers MUST read the following text <br /> I cerilfy that I have a program in place.to reduce the volume and toxicity of waste generated to She degree 1 have dc+tarmined to be economically practicable and that I have selected the <br /> practicable method of.treatment,storage,or disposal currently avallabie to me which minimizes the present and future lineal to human life and the environment. <br /> Thks Individual signing In the space set forth below on behalf of Customer represents and warrants that hclsho has the aulharlty.to hhtd customer,that the forgoing descriptions of waste <br /> and materials ore true and accurnte as packaged,marked,and labeled,are ready for traneportatlon In accordance with appllcabde stele and federal regulallons,and that customer shall abide <br /> by the Standard Terms and Conditions all <br /> the reverse side of this Service Order. <br /> 8r a Orders with an associated 1laxafdou5 waste mantfesi(elther alto specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration <br /> ho Manliest if, These fees vary based on Manifest type.Appllcable fees will appear on your billing Invoice. <br /> stoma/ LSig7natuJ�reee r �r Date Driver Signature Date <br /> Print Name Print Driver Name <br />