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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: N3209826 562-231-1550 '"WORLD OIL ENVIRONMENTAL SERVICESTM ' 7300 CHEVRON WAY,DIXON, ANTONINI ENTERPRISES LLC-ANT ca ssszo H ANrONI�;I ENTERPRISES LLC- UITNRQr� 1-sea-7z7•267ze�s P 70.1 D'ARCY PKVV'l PO BOX 846:3 E WWW.WORLDOILCORP.COM L,'i`1 H OP,CA 95330 TRANSPORTER EPA#CAD028277036 r� d 5 i..CK70 , CA 952.15 T (200 333 SG95 (203) 466-4300 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES AN I dUd i CUI.I—1E 1 JQ;-1N SCHEDULED-I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/.MANIFEST# -1'I011?020 4/112020 GAL✓aC10335iO3 X31-]3 J PART# DESCRIPTION QTY UNIT PRICE OTY P/U TOTAL Xlsiu i.iSEL`. )IL SER VICE C'r-IARGE WOUS2-Doll-/,'0IXcDOiL S. 390 �2(0 JOHN2C.i4166-4500 fiATCH# TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED'TSDF: ASSIJRY ENV!RONIMENTAL SERVICES-CERES, '1920 PAORu^-AN RD.,CERES CA 95358(205+)541-'i 01 5,CAL000393600 ALTERNATE TSDF: Qoss Streets: Account Managor:Sar,Read DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROP WT�:603C)- 8y si Fling below I hereby certify shat: RECD (Waste ail generator/customer MUST check ONE of the following th ee boxpe�) Cl +11)I hove 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 was doa.a nal contain any PCBs.1 have compiled with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional c r sk�f Thee 11119 sRlnt till y sate It the Information I have provided about this waste Is Incorrect ❑#2 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content Is GREATER than S,Odo ppm,and the waste does not contain any PCgs•I have provided proper documentation to World Oil Environmental Services to robul the presumption that this waste was mixed with other hazardous waste.I agree to accept ilia additional charges for tiro disposal of this waste If the Information I have provided about this waste Is Incorrect ❑ 03)This wasta Is from a lank which collocts waste off from household"do-It-yourself"(DIY)ondlor condilionnlly exempt small quantity generator[CESUG)sources.7o the hest of my knowledge,the only wasto oil contained In my DIY?CESCG collection lank In soley from DIY im0lor CESOG sources.I have not mixed Ihls waste oil with any olhor hazardous waste or waste oil ,from other sources,I agree 10 accept the additlonal charges for disposal of this waste tithe Information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text 1 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 minimizes the present and future threat to human life and the environment. This Individual eignlFlg In the space sot forth below an behalf of customer represents and warrants that he/she has the authority to bind Customer,that the forgoing descriptions of waste and materials aro true and accurate as packaged,marked,and labeled,are reply for transportallon In accordance with applicable state and loderal regulations,and that customer shall abide by the Ste ndard Terms and Con4Ittans an the reverse sl de of this Service Order. Sent lee Orders with an assoctnted hazardous waste manIle at(either site apeclfle or consoWeled)are subject to an EPA Fee.These fees cover the EPA pass-through fee and ad min Istratlon JCustCer l progre These fess vary based on Manifest type. Applicable fees will appear on your h(iling Invoice. r Signature P-atf3D ver Signature Date ff Print Name Print Driver Name