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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO. WOES004-B(8/18) 1.800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: N2917146 562-231-1550 WO R L a O I L ENVIRONMENTAL SERVICES,. H ANTONINI ENTERPRISES LLC- LATHROP7soo CMEVHo�v WAY, 1 snva27- a7s 2879 cAsss2o ANTONINI ENTERPRISES LLC-A 1 701 DPO BOX 8466 P 'ARC'Y PKWY LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 S T OCKTON, CA 9521 o (209) 993-8695 (209) 466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES AN I 10L.16 R JU_IE 114 �� JUHN SC:HEL)1JLE©-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 5/1212019 6/'412019 CAL000365703 (91Z.266-757c� F� PART# DESCRIPTION QTY UNIT PRICE CITY PIU TOTAL 11S lL SSR IGE CH ROE 1 thio USED OIL f MIXED OILS gap 0 JOHN 20 4813-000 BATCH O TOTAL CASH-REC'D: '€ CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILtMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS.,WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER. DESIGNATED TSDF: i7 t , 7 W RD., a {213 as - r, s 6p ALTERNATE TSDF: Cross Streets: A=0lrf1 I - DRUMS P/U: ° EMPTY DRUMS: FACILITY:_ BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPRATE BOX)-.••...-....•... By signing below I hereby certify that; (Waste oil generator/customer MUST check ONE of the following three boxes) #1)l have not mixed any of She want@ do"rlbed alcove with any dl her hatardobs waatc,the total halide content la LESS Ihim 7,6x4 ppm,and Iho waste does not can to In any PCBs.I have complied wlth the requlrementa Of tha applicable CalliernIs used all manogomont ragutatieno to determine 141a la Irue.I agree to anocpl the Additlanal chargco tor ths dlsposoI of thle waste If the Informatlon f have proV110d about this waste I Ineomal Q 92 l havo not mixed any of the waste daacrlbed above wlih any other hazardous waste,Iftn total hal Ida content la GREATER than 1,D00 ppm,and the waste does not contain any PCBs,I have provided proper documentation to World Cil Environmental Services to rebut the presumption lhot this wants was mixed with other hazardous waste.f agree 10 accept the addlttnnal chatgeo for the disposal Of thin waste If the Information I have provided about ihiawaste is Incorrect 0 03)This want©Is from s tank which celiects Wants Olt from household"do-it•yovrself"(MY)endlorconditionally exempt atdaltquantity generator(cEsaa)sources,To the best of my knowledge,the only tyamis oil contained in my 01Y/CESOG collection tank fa onlay from e1Y andlor CESOG soureae.I have not mixed this waste at)with any other hazardous waste or waste oil from other conecre,t agree to accept the addlttonal charges for diuposol of thin waata If the Informatlon f have provided about atria waste In Inearraot (All generators/customers MUST read the following text I corlify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economlanily practicable and that I have selected the practicable melhod of ttoalment,alorage,or dfaposal currently nvallsbia to me which minlmlzes the present and future threat to human life and the environment. This individual sfnning In the spaco eel forth belay on behalf of customer represents and warrants that hdshe has the authority to bed customer,that the forgoing descriptions of waste and materials are truo and accurate as packaged,marked,and Inbaled,or ready fortronsportallon In accordance with applicable sfaleand Moral regulations,and thnl customer nlu+lt abide by the Stnndord Torma nod Conditions on the rovornn side of this SorWco tlydnr. Service Orders with an assoclatod ttozardeun wasla manifest(elthor site apeclflc or consolidated)are subject to sn EPA Fee.Thos fees cover the EPA pass-through lea and adminlstratlon or Iha emanifass program. These fees vary based on Manifest type.Applicable fees will appear on your billing invalce. /�/q Cus om� ignature Date river Si lure Date i Prnt am �� Print Driver Name