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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL.SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: C�' N2720718 562-231-1550 O R L D O I L ENVIRONMENTAL SERVICES,. s 7300 CHEVRON WAY,DIXON,CA 95620 " ANTONINI ENTERPRISES LLC- LATHROP 1-800-727-2879 ANTONINI ENTERPRISES LLC-A P 701 D'ARCY PKWY WWW.WORLDOILCORP.COM PO BOX 8468 E TRANSPORTER EPA#CAD028277036 T LATHROP,CA 95330 STOCKT'ON, CA 95215 (209) 993-8695 (209) 466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ANT608 ROUTE 124 0/ JOHN SCHEDULED-I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 11/9f2018 10131/2018 CAL000385703 Dyr PART# DESCRIPTION QTY UNIT PRICE QTYP/U TOTAL WQ6U L16hU UIL Sf=RVICI=CHARUE� 7 WO USED OIL/MIXED OILS 240 .3c10 JOHN 20.-X486-4800 BATCH* TOTAL 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: X DESIGNATED TSDF:�5$�I$Y ESE;Q�gF{YTAL SERVICE,��i.1flZ4BC�9C�LRD�.�E13ES„CA A535@(Z119)"�4LiB25, LflA030 ALTERNATE TSDF: _Cross-Streetrm DRUMS PN: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRITE BOX) By signing below I heroby eertlfy that: 8 (Waste oil generator/customer MUST check ONE of the following three By I have nol mixed any of the wealo done Ilbod above with any 0kher haxardeus westo.the total halldo content le LESS than 1,000 ppm,and the waste doer,not contain any PCBs.I have eomptled with the requiromome at the applicable California used oil management rogulallons to drdormine this Is 1ruo.I ograa to accept the addlltonal chargos for the disposal of thin waste If the Intarmallon I have provided about this waste In Incorrect Q 121 have not mixed any of the waste described above with any other hazardous waste,the total halide content(a GREATER Ihen 1,000 ppm,and the waste does not contain any PCBs. have provided proper documentation to World GR Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accupt tho additional charges for Ilia disposal of this waste If the Informatlon I have provided about Ne.waste Is Incorrect 0 03)This waste Is Irom a lank which collects waste all from household"do-It-yourself"(131Y)and/or conditionally exempt smell quanilty generator(CESGG)saarcos.To the boat of my knowledge,the only waste oil contained In my DIY/CESGG collection tank is soley from DIY and/or CESGG sources.I have not mixed this waste oll with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste It the Information I have provided about this wasto Is Incorrocl (All generators/customers MUST read the following text I cartily that I have a program In place to reduce the volume and toxicity of waste gnneraied to the degree 1 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. Thle Individual eigning In the space set forth below an behalf of customer represonts and warrants that hdAha has tha authority to bind customor,Viol the forgoing descriptions of waste and materials ars truo and accurate on packaged,marked,and labeled,are ready forlrancporwilon In atcordnneawith applicable aceto and federal taqulations,and that customer shit abldo by iho Standard Terms and Condltlons on Thereverea aldo of thin SuMca order, Service orders with an associated hazardous waste mardlaat(cllhut alta apoclllc oldotsd)are subject to an EPA Fee.Thoso vs co a EF mAhrough fee and administration of the eManifest program. These fees vary based on Mar lfast typo. ;p ticabio ee Alyilappear on your billing Invoice. L 41& r u r gn ateDriver Signator Wate 21nt Name Pr[nt DrWr--r harna