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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: fN3180059 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES- H C' I ti.P r I �_� 7300 CHEVI90N WAY, DIXON,CA 95620 rw I ANT'ONINI E=1NTEERPIR!SLES ,_LC. - LA i HROP 1-800.727-2879 AN T ONINI-ENTIERPRIS"ES LLC-ANT P •7,)1 D'ARC`;'R1411'�J`fr PO PO SOX 8468 E TRANSPORTER EPA#CAD028277036 T LATI-11CA ;5330 S1.6614TON, CA 95215 0 (209) 993-8c7Q5 (209) 4,65-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES AiNT608 C..ER-Sr v JO;INISAI I ?EAD srn� 'tirtez iDATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 2/28/2020 •CAL0003w5703 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 0FDFc OIL FILT ER DRUM RERLAC5ElviEt4Tl- NO CHARGE 4 l� 0i USED METAL OIL_ANr)1GAkOUNE FILTERS a. i1 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: ti,1-Rinr.rzn axGnr r,n�Ir. �rrn rrc C.1t tipp,rr_[7e M1nMrrrr•s 5'r*r r.n r.2, DESIGNATED TSDF:V` _--�—•r'7'� AM-FRIC51u IL,i ITF Lr I n{ t c_ nn: F7/.t n51'a.s (96P) . %e( ati l f]Qi}&i;f00 I ALTERNATE TSDF, _ Cm s rs�Prc �, _ P,ccaulrt 1U acFe� i1 Fe�:lrf DRUMS PIU: EMPTY DRUMS:_ FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE B ( By signing below 1 hereby certify that: j (Waste oil generator/customer MUST check ONE of the following-thre6tioxes)• Q #1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste does not aontal'a-any PCHs.�have compiled with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 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 woste docs not contain any PCBs.I have provided proper documentation to World Oil Envlronmenfai 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)have provided about this waste Is Incorrect Q #3)This waste Is from a tank which collects waste all from household"do-It-yourself"(DIY)andler conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESQG collection tank Is soley from DIY andler CESQG sources.I have not mixed this waste 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 he economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and 1he environment. This Ihdlviduat signing In the space set forth below on bahalf or customer represents and warrants that halshe has the authority to bind customer,that the forgoing deacriptlons of waste and matedats are true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and lederal regulations,and that customer shall abide by the Standard Terms and Conditions on[tie reverse side of this Sarvlce Order. Servlceam ers with an associated hazardous waste manifest(either site specific or consolidated)are subj�ect to an EPA Fee.These fees cover the EPA pass-through fee and adminlstrallon of Ih ar Rest agram, These fens vary based on Manifest type. Applicable fees will appear on your bfllTng Invoice. —4 , 1 - - ill C s r Signature Date _ Driver Signature Date 07, 11 /,r;a s Sr ,c k - DcA vii, I/VI- Print Name Print Driver Name