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FOR SERVICE CALL: SERVICE ORDER FORM NO, WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER N0. <br /> FOR 562-231-1650 ACCOUNTING CALL: GWORLD O M L <br /> ENVIRONMENTAL 5ERVICESTM <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H <br /> I 1-800-727-2879 <br /> P ANTONINI ENTERPRISES LLC- LATHROP ANTONINi ENTERPRISES LLC-A <br /> PE 701 D'ARCY PKWY WWW.WORLDOILCORP.COM PO SOX 8468 <br /> n TRANSPORTER EPA#CAD028277036 <br /> T LATHROP,CA 95330 STOCKTON, CA 95215 <br /> (209) 993-8695 (209) 486.4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT806 R)UTE 124 g001 JOHN SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 3/1312019 315/2019 CAL000385703 <br /> PART# DESCRIPTION OTY UNIT PRICE QTY P/U TOTAL <br /> WOSC USED OIL SERVICE CHARGE 1 0 <br /> WO USED OIL/MIXED OILS 170 <br /> 10WN 2C d66-4900 BATCH* <br /> TOTAL <br /> CASH REC'Dt CHECK# <br /> WASTE DISPOSAL 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: <br /> ALTERNATE TSDF: �B>IRY-Ef , 0 <br /> ly <br /> [ISS Ca caun anag „„ <br /> DRUMS PN: EMPTY DRUMS: '- FACILITY: BSC U <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIA O � � 2019 <br /> By slgning below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following thre <br /> 11)1 have nol mlxod tiny of the waste described above with any olhor hazardous waste,the tole)halide conlent Is LESS than 1,00 ppm,and the wasto dopa not contain any PC s. <br /> compliod with the requirements of the appPenwe Calllornla used oil management regulatiana to dolormino Ihts la true.t agree to eccopt Sha nddlilonal chargoa for the disposal of this waste If <br /> the Information;hava provided about Stile waste Is hlcoernct <br /> Q 12 1 have not mixed any Dt the waste described above with any other hazardous waste,Iho lntal halide content Is GREATER than U00 ppm,and the wosle does nal conlaln any PCBs. <br /> have provided proper documentation to World 011 Environmental Servicoa to rebut the prosumptlon that this waste was mixed with other hnzordeba wanto.I numeto aocapi theaddlllonni <br /> charges for the diapocal of this wants if iho Information I have provided about thla waste is incorrect <br /> Q "This waste fa froro a lank whlch collects waste oil[rein housahold"do-it-youracit"(MY)andrwcondltlonnily oxempi small quantity generator(CESOG)sources.To the best of my <br /> knawlodgo,the only waste oil contained in my ONCESOG collt:stlon mak is coley Iram nlY and/orCESOG strurces.I have not rnlxed Ohio waste oil will any other hazardous waste or waste oil <br /> from other mourcas,I agrao to accept the additional charges fordisposal all thlg waste 11 iholnformatlon I live provided about 111ls waste Jr.Incarrect <br /> (All generators/customers MUST read the following text <br /> 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 be economically practicable and that I have selected the <br /> practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future throat to human life and the environment, <br /> Thla ladivtduet signing In the Space sot ronli botow on bahair of customer representsand warrants that helshe has the authortly to bind customer,that the fargoingg descriptions Of westo <br /> and materials are true and accurate as packaged,marked,and totaled,are ready for trarlspottatlon Inaccordanw with applicable aisle and federal regulations,and that custonwr Mail abide <br /> by lho Standard Tormu and Condltlone on tho reverse aldo of this SaNI Order. <br /> 5erulca orders w11h an aasaciatad haxardolls wears mnnlloat(either site specific or consolidated)are subject to an EPA Fee peso fees e r iho EPA pass-through fee and administration <br /> et she a nilest program. 7haao foes vary basad an INnnlfeat type. Applkahl�a lUees will appear on your bi ling invoice. <br /> AJA092—� <br /> Stom Sig tura Date Driver Signature Date /4 <br /> r Print Name <br /> Print Driver Name <br />