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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: �� OIL 1J2847921 562-231-1550 ENVIRONMENTAL SERVICES,. DIXOs ANTONINI ENTERPRISES LLC- LATHROP7300 CHEVRON WAY,1-000-727-2879fl0-727- 879 2879 cAsSBzo H ANTONINI ENTERPRISES LLC -A P 701 D'ARCY PKWY PO SOX 8468 P WWW.WORLDOILCORRCOM LATHROP, CA 95330 TRANSPORTER EPA#CAD02677036 o (2Q9) 993 8695 ST+OCKTQN, GA 85215 (209) 465-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES AW608-608- CER-86 JUH(`J srrta rtl neZ DATE REQUIRED DATE.ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 3121/2019 CA L000385703 PA_RO T# DESCRIPTIQTY UNIT PRICE QTY P/U TOTAL ;7USED IV AL c PILTERS -+ OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE 4 JOHN 20%A66-4900 BATCH# TOTAL CASH REC'D: CHECK# ...._..............-. WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: t- i IS tlrfASrF Si"]IIr]/£1LTE>3S0IIAlNICrtC�1L1 sTATEco[J>=aa�_ x DESIGNATED TSD!✓: Yts N7ANAc52M=NT,wc.,8300 US HIGHIMAY 95,TUMA,Az asZe1,aZ]9-344-Saxe ALTERNATE TSDF: Cross c •�Lt Account manager. �J DRUMS PIU: EMPTY DRUMS: — y FACILITY: BSC 1� GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIAT x)m"H 4 2019 By slgntng below I hereby cenily that: $� rtrt (Waste oil generator/customer MUST check ONE of the following three u #1)I have not mixed any of the waste deaeribed above with any other hazardous waste,the total hallde consent Is LESS than 1,000 ppm,and the waste does not comate any PCBs. compllad with the requlramonts of the applicable California used all managamont 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 #21 have not mixed any of the waste described above with any other hazardous waste,the total hallde content Is GREATER than 1,000 ppm,and the waste does not contain ens 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 the disposal of this waste If the Information I have provided about this waste Is Incorrect Q #3)This waste Is from a tank which collects waste all from household"do•It-yoursell"(DIY)aruf/ar candillonally exempt small quantity generator(CEsaG)aaufces.To the beat of my knowledge,the only waste oil contained In my DIY/CESOG collection tank Is saley from DIY and1or CESGG sources.I have not mixed lhla waste oil with any other hazardous waste or wasto oil from other sources.I agrao to accept the additional charges for disposal of this waste It 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 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 la human life and the envlranment. Thta individual signing In tho space set forth below an behalf of customer represents and warrants that he/she has the autharlly to bind customer,that the forgoing descrlptions of waste and materiels are true and nccurate as packaged,marked.and labeled,arc ready for tfarrsportetlon In a000rdanoe whh appllenble stela and federal regutellons,and that customer shall abIda by lha Standard Tstnts and Condlilons an the reverse nldo of 1h1,Service Order. Service Orders with no crated it s eus stn mam(fast(either site npcclfic of consolldaled)are subject loan EPA poo.Tit a fees cover the EPA pass-through fee and administration of the elda t ra These 4ary ed an Marlifesl type. Applicable fees will appear on your billing Invoice. Custom Ignature Date Driver Signa ure Date o.,..a t.r....... grin! f1rl,rnr Alamo