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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: ��� i''J29�9CJ•5•a562-231-1550 GWORLD <br /> ENVIRONMENTAL SERVICESTM <br /> s 7300 CHEVRON WAY,DIXON,CA 95620 <br /> IANTONINi ENTC:iRi�R!S S LLC;- LA i I-1ROP 1-800-727-2879 ANTONINI ENTERPRISES LLC-A <br /> P WWW.WORLDOILCORRCOM PO SO%ti 8^'168 <br /> � TRANSPORTER EPA#CAD028277036 <br /> T !_, T Hr:OiJ,C:, 533C' STOCKTON, CA 115215 <br /> 0 ,2'C)�111l a 6 9 5 f209) 4664900. <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> A 1,,"F 6'08 R'DU T rE 1214 1)11 JOHN SCHEDUL_D-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/M�A]NIFEEST# <br /> Y/1 5/20119 7191201'9 CAL0003S570 gv ���oC (/ VTF.. <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> W0IS30 USED OIL S;EIRVICE CCHA-ROE 1 <br /> WO USED OIL/MIXED OILS 330 ,Q� <br /> JFJHN 20,•16G-4900 3ATCi�,r <br /> TOTAL <br /> CASH REC'D: CHECK/1 <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: MORGAN RD.,CERES.CA 95 - ;;. } _v,449,WALGaaaxma <br /> ALTERNATE TSDF: <br /> -- _ Acca f ana�ar'S�i7 1 ea f <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC JUL '2019 <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPR�AgiM�BD}C] � <br /> jBy signing below I hereby certify that: ��» <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 4)1 have not mixed any of the waste dijscrlbed above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have <br /> compiled with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If <br /> the Information I have provided about this waste Is Incorrect <br /> Q #21 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 does not contain any PCBs.I <br /> have provided proper documentation to World Oil Environmental Servlces to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the.dlsposal of this waste if the Information I have provlrled about this waste Is incorrect <br /> Q #3)This waste is from a tank which collects waste oil from household"do-It-yourself'(DIY)and/or conditionally exempt small quantity generator(CESCIG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank Is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> 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 <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 to me which minimizes the present and future threat to human life and the environment. <br /> This Individual aigntng In the space set forth below on behalf of cumomor represents and warrants tiwt helaho has the authority to bind customer,that the forgoing descriptions of waste <br /> and mnlerlals are Irue and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations,and Ilia]customer shall abide <br /> by the Standard Terms and Condlllons on ttw rovorse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an I P These fees cover the EPA pass-through fee and administration <br /> of the eManifest progra These ryes very based on Manifest type. Applicable fees will appear on your billing Invoke, <br /> Cus mer S gnature Date rI J11gnature Date <br /> eZ <br />