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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (4/17) 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: N2696892 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES,., s ANTONINI ENTERPRISES LLC- LATHROP 7300 CHEVRON WAYrDixON CA 95620 ANTONINI ENTERPRISES LLC-A 1 701 D ARCY PKWY 1-sde-727.2879 PO BOX 8468 P E LA T HROP, GA 95330 D WWWWORLDOILCORP.COM STQ[:KTQN, CA 9515 T (209) 993-8695 TRANSPORTER EPA#CAD028277036 (209) 466-4900 D CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES AN 1 UVU f'G rV 11- IG"T 13LG1+Lvll DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 10/vr20!o �.A-%L nluJva f AU 35 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL lruvut U, I D VIL 3'SR V ilr ft,HARvE WO USED OIL/MIXED OILS 100 zt/o JOHN 209.466.4900 BATCH 0 EffectiVe 7 112019:Service orders with associated haz waste manifests(site speclfic/consolid,ted)are subjec to an EPA Fee. Fees cover EPA pass- through fee and administration of the eManifest program. Fees vary from$4-$10 based an R anifest type. A aplicabie fees w+I afi.s ear an your Invoice, �1Al_ CASH RECD: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER-It A413URY ENVI12C}111111IENTAL !qg1210ES C)E1;5.192�j0$Q�N Rid,CERES.058.(2.2)541-1925,CAL60[13A -0 DESIIRG��N�ATEDTSDF: A i[75�11�5; --- unt.Managsr Toeld Nsi It DRUMS P/U: EMPTY DRUMS: FACILITY: BSC r I GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE SCS p i By signing below I hereby certify that: O C T 2018 S (Waste oil generator/customer MUST check ONE of the following three boxes) (Vm I)I have not mlwd 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 a ve compBed wlllt the requirenients F !,e applicable California used oil management regulatlnns to determine this Is true.I agree to accept the additional charges for the disposal of this waste If the Information fide prtiv ded about tltTyp3 3 tncorreet� O#2 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 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 thedisposal of this waste if the information I have provided about this waste Is incorrect =143)This waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my ON CESQG collection tank is soley from DIY and/or CESQG sources.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 have provided about this waste Is incorrect (All generators/customers MUST read the following text and check the associated box.) `V R4)If l am a targe quantity generator,I certlfy tNi l have a program In place to reduce thevolume 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,stardge,or disposal currently available tome which minimizes the present and Future threat to human life and the environment;Or,if I am a sntaj qua ttty generator,l have made a good faith effort to minimize my waste generation and select the best waste management method that is available tome that I can afford. 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,that the gdescriptlons atea tatorWs are true and accurate as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer shall abide o bound by the ndarclT In and Conditions on the reverse side of this Service Order. r CustOmer 5lgnure Date Driver SignatureDate Print hlamo Print Drivers Na