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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: , N3202601 <br /> 562-231-1550 WORLD O I L <br /> ENVIRONMENTAL SERVICES, <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> " ANTONINI E.P`TERPRISES LLC- LATHROP ' 1-800-727-2879 ANTONINI ENTERPRISES LLC-ANT <br /> P 701 D'ARCY PKWY PO COX 8468 <br /> P WWW.WORLDOILCORP.COM <br /> D TRANSPORTER EPA#CAD028277036 r <br /> T. LATI IROP,CA 9;33C� STOCKF.ON, CA 95215- <br /> o (209) 993-8695 (209) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN-1608 CE-N-86 JOIN SGHEL)ULEQ-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 4/212020 3/25/2020 CALCO0335703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PN TOTAL <br /> OF USED NIETAL OIL AND GASOLINiw FILTERS 4 <br /> OFDR OIL. FILTER DRUM REPI_ACEMC'NT- NO CHARGE 4 / <br /> JOHN 2(9-4.66-4400 BATCH J0 <br /> TOTAL <br /> CASH REC'D: CHECK# <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: NON-RCRA HAnkRr701IS LNASTF y01 10 Wl ITFRS(1I-11l1`rA[f+li C3 nil,I STAT F C OLIF 17- <br /> J DESIGNATED TSDF: AMERICAN VALLEY"WASTE OIL,521 INDUSTRIAL DRIVE,SUI T F,N1, LIVINGSTON,CA 95334, (6.00)732-4045,GAIL 00443001 <br /> ALTERNATE TSDF: <br /> Cross , -els: Accounta •-- rafn ReAfi <br /> /p " <br /> DRUMS P/U:- EMPTY DRUMS: FACILITY: BSC ff <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROP 1 TE 8%3 2020 Al,IJ <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer mer MUST check ONE of the following th b.b es <br /> ❑#1)1 have not mixed any of the waste described above with any.other hazardous wastot the total halide content is LESS than 1,000 ppm,and the waste does not con faTn-anv,PC�1•have� <br /> complied with the requirements of the applicable Callfurnla used oil managemc�t reguintlons to determine this Is true.I agree to accept the additional charges for the disposal of this was •R <br /> the Information I have provided about this waste Is Incorrect <br /> ❑021 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 PCs$.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to aocopt the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> ❑0)This westa is from a tank which collects waste oil from housahold"do-it-yourself•'(DIY)andfor randltlonaliy exemptsmall quantity ganoralor(CESOG)sources.To Iles bast of my <br /> knowledge,the only wemio oil contained In my DIY,CESOG collection tank Is soley from DIY andlor CESOG seuroes.I have not mixed fits waste all 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 providod about this waste is Incorrout <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 signing In the space"I forth below on behalf of cuslgmor topfasents and warrants that he/she has the authority to bind customer,that the forgoing descrlptlons of waste <br /> and materials are true and accurato as packaged,marked,and leboled,era ready for transporlallon In accordance with applicable stain and federal regulatlons,and that eustomar shall abide <br /> by 1 he Standard Terms and Conditions on the reverse side of Ihis Service Order. <br /> Service Orders w1lh an associated hazardous wosta manifest(either site specific or consolldated)are subject to an EP=Signature <br /> e EPA pass-through fee and administration <br /> of the aManlfast Progrrm. These fops vary booed on Manlfost type. Applicable fees will appear on your billing Invoice <br /> Cus om r gnatur Date Date <br /> � r f <br /> I L / '(-, _lY <br /> Print Name Print Driver Name <br />