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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL.SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: OI 562-231-1550 G,' WORLD OIL I12858833 ENVIRONMENTAL SERVICES,. S 7300 CHEVRON WAY,DIXON,CA 95620 H 1-800-727-2879 p ANTONINI ENTERPRISES LLC- LATHROP wWW-WORLDOILCORP.COM ANTONINI ENTERPRISES LLC-A R 701 D'ARCY PKWY TRANSPORTER EPA#CAD028277036 PO BOX 8468 T ° LATHROP,CA 95330 STOCKTON, CA 55215 (209)993-8695 (209) 466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES -02 I DATE REQUIRED DATE ENTERED NEXT SERVICE DAT5- CUSTOMER EPA# BILL Off LEADING/MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 7 -1 W05C USED OIL SERVICE CHARGE 1 3,!�o wo USED OIL�MIXED OILS 1$0 JOHN 209 466.4900 BATChf# TOTAL CASH REC'D: CHECK WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CO221AP R 1 G 2019 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE COI? OTHER: _ DESIGNATED TSDF: - r ALTERNATE TSDF:__.�� F; O�11"�''=rt=es1�`ES-C f2cN " i>n�3RBAN Rte,G R�"c� 5358(2E}9}54.1- e,25;CAALGGn93680 DRUMSW Streets. EMPTY DRUMS: FACILITY: BSC Account Manager:Sam Read GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby cortlfy lhnt- (Waste oil generator/customer MUST check ONE of the fallowing three boxes) J91)I have not mixed any of the wa:llo described above with any other hazardous waste,the talel halide conical la LESS than 1,aaa ppm,and the waste does not contain any PCBs.I have compiled with the requirements of the appiicable California used oil management regulations to determine this is Iwo,i agree to oecept the addllieacl charges for the disposal of this waste If the Information l have provided about this waste Is Incorrect Q 82 I have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than 1,000 ppm,and the waste docs not contain any PCBs.I have provided proper dacumentallon 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 1 have provldad about this waste Is Incorrect Q R3)This waste Is from a tank which collects waste all from household"do-It-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the beat of my knowledge,the only waste all contained In my DIY/CESOG collection lank Is soloy from DIY and/or CESOG sources.I have not mixed this waste all with any other hazardous waste or wash all from other sources.I agree to 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 be economically practicable and that I have selected the proclleable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. This Individual algning In the apaco set forth below on behalf of cumtomar raptesents and warrants that heJaha Iles Ma authority to bind customer,that the Forgoing descriptions of w4sto and malmlaisace true and accurato as packaged,marked,and labeled,are re' fortranaportallon In accordance with applicable state and federal rogulatiana,and that customer ahail abide by the Standard Terms and CandilIona an the ravorca aids of INa Sorvlca Order. 5arvlAa ra with an aasocloted hazardous waste manilont(eilfier alte specific oreonsolldatod)are Bub eat In an EPA Q. heso fees cover the EPA pass-through fee and administration Mho den fest p ogram. Tti Laos vary b r on ittanlfem typa.Applicable fens wilt appear an your belting Invoice, CUt7 - ! atur Date r Ver Sig Lure Date S Print Name Printr[I I�erame