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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. f dSO��> 79 562-23 6-ACCOUNTING NTING CALL: �j WO ORLD ® OI L ENVIRONMENTAL SERVICES,,, s 7300 CHEVRON WAY,DIXON,CA 95620 " A.NTONINI ENTERPRISES 1-1_C- L-P H'ROP 1.800-727-2879 Af i FONINI �`I T�IiRR Stw LLC- AN i P '701 D'ARCY PKVYY PO O «<^.,fie WWW.WORLDOILCORP.COM ol_;1TF TROP, rf5 ^533Q TRANSPORTER EPA#CAD028277036 95215 T �7 I CCK T ON. CAA O (200 993-869 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL WOS C USED OIL;c;;ViCE CHARGE 1. Wo USED OIL/ MIXED QIL;S 150 �.=u.:i•i 1.)-466-4900 F5A1'C:N ' TOTAL CASH REC'D: 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: ASI3UFi.1'�iVVIF.�3rllti�c?y'iA} �yCf?VIC�S-LtP.�s I92�Ivr�12�3,s�,�:;;CI fdES CA 95"s58 f2[l8]a"4f-59"5 r'�L!}U0; 3�i80 ALTERNATE TSDF: Crosiz St°ea'LE' Account iviaraOe�-,Sarn Pic+Bc} DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROP' AT"OX) 01 lay *'Ing below I hereby certify that: )-l4 k U r j ! (Waste oil generator/customer MUST check ONE of the fol lowingl'three boxes) ! 01)I have not mixed any of the waste described above with any ether Ilazardous waste,the total halide conlenl Is LESS than 1,ogo m,and It:JJ ni'- ` Pp t v+aato4opdnnt•contaln-enyPLDs.Ihave, complied with the requlremmnts of the applicable California used 4311 management re2ulallona to datormine Mils is true.I agree to accept the nddhlonal charges for E dlspgsal of thlsw_�st It the Information I Itavo provided about this waste is Incorrect 0 #21 have not mixed any of the waste described above with any other hazardous waste,the total halide conlonl Is GREATER than M100 ppm,and the waste does not contatn any PCBs.I have provided proper documentation to World Oft Environmental 5ervfces to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the addltlonal charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect Q 031 This waste Is from a tank which collects waste ell tram household"do-it-yourself'(DIY)endlor condltlonally oxompl small quantity gonaratar(CESQG)sources.To the best of my knowledge,the only waste oil contained In my DIY(CESQG collection tank Is soiey from DIY andlor CESQG sources.I have not mixed[his waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste If the Informellon 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 minlmlzes the present and future threat to human life and the environment. This ladivIdual signing in the space set forth below an behalf of customer represents and warrants that Ilalshe ties the authority to bind customer,that the forgoing dr,scrlptlons of waste and matorkols ure true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and tedeial regulations,and rhn!customer shall abide by the Stnndard Terms and Cundilivns on the reverse side or ihiii Service Order. 5ervlce Orders with an associated hazardous waste manifest(either site specific or consolldaled)are subject to an EPA Fee. eaa fees cover the EPA pass-through fee and administration of eta 11am program. These fees vary based on Manifest type. Applicable fees will appenr on your billing Invoice. CUS OMer S gnat 'a Date r' gnature Date Print Noma Print nritrar Nnma.