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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: (;� wor&D 01L N2748871 562-231-1550 ENVIRONMENTAL SERVICES,. H ANTONINI ENTERPRISES LLC- LATHROF7300 CHEVRON WAY,DIXON,CA 95620 ANTONINI ENTERPRISES LLC-A P 701 D'ARCY PKWY 1-800-727-2879 PO 130X 8.466 P WWW.WORLDOILCORP.COM D LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 STOCKTON, CA 95215 T (209) 993.8698 (209)466.4900 CUSTOMER# PURCHASE ORDER # ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES A y 1 vvv uu 1It I,44O„A JurilIq V DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LA DING/ MANIFESST# "I/J1 W;CM a "IYJ41LU16 UALUUWd!31W O 1- 1 G (� 0 1 3" P R 61 1ARGE Q UNIT PRICE OTJY P/U TOTAL Vr o USED OIL/ MIXED OILS 340 1�j JOHN 201-464900 BATCH* TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSIDF: ASM EN TA SER CGI ES-t;ERES,1920-NEORCfWd ff' CEREs.CA X 58 t209�5dt-10 993980 ALTERNATE TSDF: Cross Streets: AccountManager; a nt DRUMS PN: EMPTY DRUMS: FACILITY: RSC G1ENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) S elgning below I hereby certify that; (Waste oil generator/customer MUST check ONE of the following three foxes) 61)I have nor mixed any of the waste described above,wllh any olhur hazardous waste,the IotAl hailde content Is LESS than 1,000 ppm,artd the wash does tat contain any PCHe.l have compiled with the requlremenls 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 about this waste Is Incorrect 0 1121 have not mixed any of the waste described above with any other hazardous waste,the total hallds content Is GREATER than 1,000 ppm,and the waste does not contain any PLDs. 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 0 a3)This waste Is from a tank which collects waste oil from household"da-It-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESOG collection lank Is sotoy from DIY and/or CESOG sources.t have not mixed this waste oil with any other hazardous waste or waste all from other sources.I agree 10 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 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 he economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minbmlzos the present and future threat to human life and the environment. This Individualslpning In lho apses set lorlh below an behalf of cuutomar represents and vrarrants that he&ha baslhe aulhoray to bind customor,ifisl Ilia forgoing doserlpllons of waste and materials ore true and adcw¢ls as packaged,marked,and labalsd,era ready for Irancporlollon In aceartlanoswllh?HnDr�i�ver ta an federal regulations,and that customer shell abide by the Slandord Tarms and Condlilonson the ruvomo aide oflitis Service Order. Service Orders with an aasocfatep hazordoua waste monifeal(elther elle specific or consolfdaled)ore Bublect to as EPees ver the EPA pass-through fee and administration It"' o' ifosi program. ' ase aea very baeod on Itanifost typo. rAeppplleabllofees Will appear an your billfng Involce 4-4 �C tamer ign Lire 1 Date n ure Date {?jam � ��Urint Name Name f