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FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/1B) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1.800-727.2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: G)WORLDOIL N2889124562-231-1550 ENVIRONMENTAL SERVICES, fit ANTONIN! ENTERPRISES LLC- LATHROP7300 CHEVRON i-aa0.72r-z679 2CA 95620 ANTONINI ENTERPRISES LLC-A �2s7s P 701 D'ARCY PKV,/Y PO BOX 8468 P WWW.WORLDOILCORP.COM ° LATHROP,CA 95330 TRANSPORTER EPA#CADD28277036 STOCKTON, CA 95215 T (209)998-8695 (209) 466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES N,4 I oua fi ru 1 C '1 24 JUHIN r1�LJUl_CU I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 5/13/2019 517f2019 CAL000385703 135 .2&&15 f j I PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL WUSC. U�:rU UIL tit XVIU--UHAKUC 1 0. WO USED OIL/MIXED OILS 320 JOHN 20B 466-4900 BATCH# TOTAL CASH RECD: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: A d 2(1MQ RL1.CERES, 2 O ALjERNgT TSDF: �.fOSS trL�f3C�,; GCOuriFiJfanager: amRead DRUMS PIU: EMPTY DRUMS: FACILITY: BSC ikpia�-j GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRI B V q By signing below 1 hereby certify that: r / z�j9 (Waste oil generator/customer MUST checic ONE of the following thr [boxes) �1)i have not mixed any of the waste doscftbed above with any other hezordouo wnale,the total kolida ccntom is LESS than 1,0110 ppnu and the waste 1n eny PCaa.1 have compiled with Ito requlromartto of tho applicable California used all managoment reguintlans to dalarmine this is true.I agree to accept the additional charges for alta If tholnformatlon l have provided about this waste is Incerroct d 421 have riot mixed any of Sha waste deoerlbod above wlth any gthor hozardot s waste,the tohd hoflde content is GREATER Ihon 1,000 ppai,and tho wdsto does not canlnln any Pcas.l have pravlded proper dacumaninllon to World 011 Environmental Gorvlces to rebut the presumpttdn that this wasto was mixed with orher hazardous waste.I agree to aacopt the addlllonal charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 0 43)This wasia to from a tank which collacta waste oil from household"do•11-yobrsoll"(01Y)and/orconditlenolly exempt small quantity ganerwor(CESOG)aourcas.To the boat of my knowtedge,the only waste all contelned In my ON CESOG collocllon lank Is aoloy from DIY and/or CESOO sources.I have not mixed this viesto all with any other hazardous waste or waste 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 bo economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes Ilia present and future threat to human life and the environment. This Individual signing in the apaoa sal forth below on behalf of customer repfaseats and warrants that ha/eho has the authority to bind customer,Ihat the forgoing descilptlons at waete and materialsera Irue and ccurate ae packagod,marked,and labeled,are randy for lranspAnation In accordance with applicable elate and federal reguletlone,and that customer shall abide by Iho Standard Torms and "aadHto a on theravoraoslda at thin Survica Order. Scrvlco0rd rawllhana9, claled iaz;7rdouswastemantresl(oiihersllaspecificorconsolidated)aresLibffecttoanEPAF These}eeacaverthaEPApass•thraughfeoandadminlatratlon dr Iho o►fa lraI program. hese as very based on Marrlfcst lypo. Applicable foes will appear on yourhfiling Involce. r /5/� Cu amer SignMu pate Dri er nature -�- Date SIS Liz tiJ i M'P/2 G' Print Namp Print Driver Name _