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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: N3373454 <br /> 562-231-1550 C\ )WORLDOIL <br /> ENVIRONMENTAL SERVICES, <br /> s ANTOfJINI ENTERPRISES LLC- LATHRO>3300 CHEVRON WAY,DIXON,CA 95620 <br /> H 1-800-727-2879 ANTONINI ENTERPRISES LLC-ANT <br /> P 701 D'ARCY PKWY WUI►IN,WORLDOILCORP.COM PO BOX 8468 <br /> LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 <br /> T STOCKTON, CA 95215 <br /> (209) 993-8695 (209) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> A77608 CER-86 JOHN SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 10/2/2020 9/23/2020 CA L000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF USED METAL 01L AND GASOLINE FILTERS 1 ,+ <br /> OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE 1 1 l <br /> JOHN 20114156-4900 BATCH# <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-SORA HAZARIMUS-.HASTE.SOLID(FILTER$CD-NIAlNING OIL)STATE, <br /> DESIGNATED TSDF: AMERICAN VALLEY WASTE OIL_,521 INDUSTRIAL DRIVE,SUITE M,LIVINGSTON,CA 95334, (800)732-4545, CAL00044300 I <br /> ALTERNATE TSDF: <br /> Cross ets: Account Manager m Read <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 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 contain any PCBs.I have <br /> compiled with the requirements of the applicable California used oil management regulatlons 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 Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> 0 #3)This waste Is from a tank which collects waste oil from household"do-If-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste all contained In my DIYlCESQG collection tank Is soley from DIY and/or CESOG sources.I have not mixed this waste all with any other hazardous waste or waste all <br /> from other sources.I agree to accept the additional charges for disposal of this waste It the Information I have provided about this waste Is Incorrect <br /> (All generators/customers MUST read the following text <br /> Iced y that I hnve a program in place Io 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 /> pram cable method of tmalosenl,storage,or disposal surreally available tome which minimizes the present and future threat to human life and the environment. <br /> T{ds ndlvldual signing In the space set forlh below on behail of cualomcr represents and warrants that helahe ties the authority to bind customer,that the lorgoing descriptions of waste <br /> and ialerials are sruc a,,d accurate as packaged,marked,and iabcied,are ready for transporintten In accordance with applicable state and federal regulations,and that customer shall ablde <br /> by t Standard Terms and Condltlons on the reverse side of this Servlca Order. <br /> So prdels with an associated hazardous waste manlresS(either elle specific or consolidated)are suhacl to on EPA Fee. �o fees cover the EPA pass-through fee and administration <br /> n cMantrest program.These fees vary based on Manifest type. Applicable fees will appear on your billing Invoice. <br /> f: ignature Dae Driv ignature Dip to <br /> Pri me Print Driver Name <br />