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FOSERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXUN OFFICE, ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: lN3:30751;3 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES S 300 CHEVRON WAY,DIXON,CA 956120 " A!N T OMNI NTrRPRISE �� i_,ATH ROP 1-800-727-2879 ANTONI".I ENTERPRISES LLC- ANT P 701 D'ARCY PK01Y PC BOX 8488 P WWW.WORLDOILCORP-COM ETRANSPORTER EPA#CAD028277036 T L ATH ROP, CAV535 3 70 1-ON, CA-05-21 5. a !209)'993-8695 (009) e66-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN'BY HALIDES AN'Trnn r.ER-86 JOHN DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIF ST# 7/22/2021 C AL0003357D,3 /8' PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL _ER8 PER DRUM O`DR OIL FiL-TER DRUM REPLACEMENT- NO CHARGE E J 0 H N?:`-466-4900 BATCH# 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 i OTHER: 1'JQN-crr:PA.I-14 Ar 001 1A INAFTF Pr11 ill tnll W PAPPPiCbl A.Tr[a 1711 TFR.q_ f1FFiRI,S1 DESIGNATED TSDF: )`S+y1Al'�Ac:EAfiEr 4T, INC.,65(]0 US HIGHWAY 95,YUiViA,AZ 85355 ALTERN F: - [-a�`ti;iaeeCs. __-.__ Account Manager.Sam Read DRUMS P/ EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE'APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 0#1)1 have not mixed any of the wast'described above with any other hazardous waste,the total hallde content Is LESS than 1,000 ppm,and the waste doa9 not contain any PCDs.I have compiled with the requlramenls of the applicable California used oil 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 allout this waste is Incorrect ❑#21 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GNEATEA than 4,040 ppm,and the waste does not contain any PCBs,l have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additlonal charges far the disposal of this waste If the Information I have provided about this waste Is Incorrect ❑#3)This waste Is from a lank which collects waste oil from household"do-It-yourself"(DIY)ancilor conditionally exempt small quantity gonemlor(CESaG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESGG collection tank Is sofey from DIY and/or CESUG sources.I have not mixed this wasto oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste If the Inlnrmation 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 life and the environment. This individual signing)n the space sot forth below on behalf of euslornar represents and warrants that he/she has the authorlty to bled cuslomer,that the lorgoing descriptions of waste and materials are true and accurate as packaged,markod,and tabeled,arc ready for transportation In accordance with applicable slate and federal regulations,and that customer shall abide by the Standard Terms and Conditions nn the reverse side at this Service Order. Service'o r art assoa d hazardous waste manifest(either site specific or consolldated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration I the anlfest program.Th-- tees very based on Mnnilosl type. Applicable fees will appear on your billing invoice. 1Lr. (MigniftreDate Drive Signature Date Print m —Print Driver Name