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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: WORLD OIL - a 562-231-1550 ENVIRONMENTAL SERVICES, s 7300 CHEVRON WAY,DIXON,CA 95620 H ANTONINI ENTERPRISES LLC- LATHROP 1-800-727-2879 ANTONINI ENTERPRISES LLC—AMI P 701 D'ARCY PKWY WWW.WORLDOILCORP.COM PO BOX 8468 D TRANSPORTER EPA#CAD028277036 a LATHROP,CA 95330 STOCKTON, CA 95215 (209) 993-8695 (209)466-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ANT608 ;OUTE 12 ��I JOHN SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 10/16/2020 10/7/2020 CAL000385703 l'V/S c- PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL WOSC USED OIL SERVICE CHARGE 1 WO USED OIL/MIXED OILS 290 40 JOHN 20 -46'6-4900 BATCH* TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS) STATE CODE 221 NOWRCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ASS 380 ALTERNATE TSDF: dross S Aca]an[�lalanag�r 5arrrR�a� DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) lay al ng below 1 heroby cortlfy that: (Waste oil generator/customer MUST check ONE of the following three boxes) I),have not mixed any of the wasta descrlbad above with any other hazardous waste,tho total halide content Is LESS than 1,000 ppm,and the waste does not conlnln any PCBs.I have complied with the requirements of the applicable California used oil 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 GRCATCn than 1,Q0(I ppm,and the waste does not contain any Pcua,I 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 addlllonal charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 0 0)This waste Is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt smell quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESOG collection tank Is soley from DIY and/or CESOG sources.I have not mixed this 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 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 piece 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 signing In the space set forth below on hohalf of customer represents and warrants that helahs has the authority to bind customer,that tha forgoing descriptions of waste and matorlols are true and accurato as packaged,marked,and labeled,are ready for transportation In accordarloa with applicable state and federal regulations,and that customer shall abide by the standard Tarms and Condillons on Iho rovarse stda of this Service Order, Servico Ordem with an assoclated hazardous waste manifest(either site specific or eonsoitdated)are subject to an EPA Fee. These fees cover the EPA pass-through tee and administration of lho oMnnlf -yprogram. These Ions vary based an Manifest type. Applicable fees will appear on your billing Invoice. -LD—OAA G�Io4'e'r Ignatui Date Drl natur Date Prf Dame Print Driver Name �� n