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4 <br /> FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES DBA <br /> 1-800-727-2876 r SERVICE ORDER NO. <br /> 662-231-1550R ACCOUNTING N2775426 <br /> NTING CALL: JL WORD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> 300 CHEVRON WAY,DIXON,CA 95620 <br /> H <br /> I ANTONINI ENTERPRISES LLC- LATHROF� 1-800-727-2879 ANTONINI ENTERPRISES LLC-A <br /> P 701 D'ARCY PKWY WWW.WORLDOILCORP,COM PO BOX 8468 <br /> E <br /> D . TRANSPORTER EPA#CAD028277036 <br /> T LATHROP,CA 95830 STOCKf ON, CA 95215 <br /> o (209) 993-8695 (209) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN 15023 UU I E 124 1- <br /> 400 JUHN SCHEDULED-I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 1/11/2019 1/212019 CAL000385703 <br /> P E R P QTY UNIT PRICE QTY P/U TOTAL <br /> YYV.7V lJ•7CV VIL.ti7Gf\V[V�t.rllr1 rL47C <br /> WO USED OIL/MIXED OILS 189 <br /> JOHN 20 13Crd900 BATCH# <br /> TOTAL <br /> CASH RECD: CHECK# <br /> WASTE DISQOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: ASBURY ENVIRONMENTAL SERVICES-CERES,1920 MORGAN RD.,CERES,CA 95358(209)641-1825,CALd00393680 <br /> ALTERNATE TSDF: <br /> Cross Streets: Account Manager:Sam Read <br /> DRUMS PN: EMPTY DRUMS: FACILITY: BSC RI.R nn <br /> GENERATOR WASTE CERTIFICATION (PC--ASE CHECK THE APPROPFVA O�)aN 11 <br /> By aigning below I hereby certify[hat: 1 .T <br /> (Waste oil generator/customer MUST chectc ONE of the following three poxes) <br /> 41)1 have not mixed arty,of the waalo darerlbad above with arty elhor hazardous wailo,the total hatfde content fa LESS than 1,6110 ppm,and the waste dq 4sixT eantaNre PG9a-Fhevn- <br /> compliod with the raqufremonto of tho appllcabis Collfornla used all rnnnagomani raguintlons to dolormllna this Is irue.I apron to accept lho eddlucnal charge a'f rpt o dCapo�sal�e!1 r a waste <br /> tho tnform mile n I have provided about thiswoato la Incomoct <br /> Q 021 have not mixed any of the waste described above with any other hazardous waste,the total halldo content la GREATER than 1,000 ppm,and the waste does not contaln any PCes.l <br /> have provided proper documenlaltan to World 011 Environmental Servlcaa to rebut the presutoptIan that InIa waste was mixed with other hazardous woste.l agree,to accept the add[Us noI <br /> chargee for the disposal of this wasto If the Informatlon I have provided about thls waste Is Incorrect <br /> 0 e3)This waste Is from a tank which collects waste oll from household"do-it-yourself'(Ulf)and/or conditionally exampl small quantity generator(CESgG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CPSUG collection tank Is sotoy from DlYand/ar CESf7G sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.I agree to accept the additional charges for disposal of thfs waste It the Information I have provided about this waste Is Incorrect <br /> (All generators/customers MUST read the following text <br /> I codify that I have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically practicable and that 1 have selected the <br /> practicable method of treatment,storage,or disposal currently available tome which mfnlmlzes the present and future threat to human life and the environment. <br /> This IndlulduaI atpnlnp in the space set forth below on behalf of customer represents andwerralfttta that harahe hsa the authority to bigdcus rnor,that the forgoing doscrlpllans of waste <br /> and matortala ars true and accuratoas packaged,markod,and labeled,nro roady for Ironspartatlon In accordnntce whh appllcablo eloto and fcdnrol regulal[nna,end thareuelnmsr shall abide <br /> by she Ston dard Terms and Dondtllons on the rovamo sida of thisSorv)ce Order. <br /> Service[Ochre with on assocloted hazardous waste monifoot(clthar alto specific orconsoltdalad)are subject to an EPA FIsere feekture <br /> he EPA pons-through fes and administration <br /> of the atLlanifnst program.Thos es any based an Manifest typo. Applicable fees will appear on your b1 ling Involco. <br /> I LA <br /> Customer 510 ur Date Driver Sign Date <br /> Print Name Print Driver Name <br />