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FOR SERVICE CALL: SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) 559-498-0240 WO 500 SERVICE ORDER N0. FOR ACCOUNTING CALL: WODIY 0 562-231-1550 N2609067 AF 110 WORLD D ®I L ENVIRONMENTAL SERVICES,. 5ANTONiNI ENTERPRISES LLC- LATHR014287 EAST MANNING AVE,PARLIER CA 93648 1-559-498-0240 ANTONINI ENTERPRISES LLC-A P 701 D'ARCY PKWY WWW,WORLDOILCORP.COM PO BOX 8468 E DLATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 T STOCKTON, CA 95215 (209) 993-8695 (209) 466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ANT608 R )UTE 124 � boj SCHEDULED-I (DATE REQUIRED DATE ENTERED NEXT SERVICt DATE' CUSTOMER EPA# BILL of LADING/MANIFEST# 1/26/2018 1/19/2018 CAL000385703 1 PART# DESCRIPTION QTY Umf PRICE QTY P/U TOTAL WOSC USED OIL SERVICE CHARGE 1 I y WO USED OIL/MIXED OILS 90 BATCH Cro;s Street's; TOTAL CASH RECD: CHECK# Account Manager: Steve Gately 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: DESIGNATEDTSDF: ALTERNATETSDF: �B FtY`lrN01 ONMENTAL S R C C- ES, l3 0 RC�ANk 863 8 2 g26,C,�L�jff$ $3�gq DRUMS P/U: EMPTY DRUMS: FACILITY: BSCa GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: J�It ,U 2018 (Waste oil generator/customer MUST check ONE of the following three boxes gy �N7)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 1 " �ppFtnL and the waste flocs not wnlaln arty PCBs_I ha s�nF�J7 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 lydorrmtlen I have pravlded about this waste Is incorrect =#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 hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect =—)93}1`W waste isfrorn a tank which collects waste-all From household'dwit-yourself(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my Off/CE50G collection tank is snley from ON andlor CESM sbuttt:s.I have not mixed this waste 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 information I ttave provided about this waste is Inico red (All generators/customers MUST read the following text and check the associated box.) rra]If I am a large quantity generator,I tertlfy that I have a program In place to reduce the volume and toxicity oFwastegem erated to Elie degree I have determined to be economically practicable and Ihat I have s leastreatment Storage,the praztkable method of treatmenstorage,or dispose]currently available to me wrhtoh minimizes the present and future threat to human life and the enviromnen4 Or,If I em a smell quantity generator,I have trade a good faith effort to minimize my waste generation and select the best waste management method that h available to me that I can offmni This individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer,t f ng descriptions of waste and materials are true and accurate az packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer sha a ide a e bound by - 1Term5 and Conditions on the reverse side of this 5eivice Order 1 Cu to er Signature Date Driver Sl a Date Uavl Print Name Print Drivers N e