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FOR SERVICE CAL!L' 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 WORLD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> S <br /> H ANTONINI ENTERPRISES LLC- LATHROp 300 CHEVRON WAY, DIXON,CA 95620 1-800-727-2879 ANTONINI ENTERPRISES LLC- ANTO <br /> P 701 DARCY PKWY <br /> W <br /> P <br /> E WW.WORLDOILCORRCOM PO BOX 8468 <br /> D TRANSPORTER EPA#CAD028277036 <br /> T LATHROP,CA 95330 STOCKTON, CA 95215 <br /> 0 (209) 993-8695 (209)466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT60-9— CER-W_ JOHN �CHM)ULED.-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE— CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 10/2/2020 9/23/2020 CAL000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF USED METAL OIL AND GASOLINE FILTERS . I <br /> OFDR OIL FILTER[DRUM REPLACEMENT- NO CHARGE <br /> JOHN 2dg.466-4900 BATCH <br /> T TOTAL <br /> CASH RECD:_ 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-RCRAi /FILTERSWAVE SOL ) <br /> ,CONTAINING OIL)STATE CODE 723 <br /> DESIGNATED TSDF: AMERICAN VALLEY WASTE OIL,52i_1 INDUSTRIAL DRIVE,SUITE M,LIVINGSTON,CA 95334, (800)732-4645, CAL00044300, <br /> HALTERNATE TSDF: <br /> Cross Account Manager:-Sam Read <br /> DRUMS P/U: 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 /> #1)I 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 /> 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 <br /> the Information I have provided about this waste is incorrect <br /> 0 #2 1 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 all from household"do-it-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 DIY/CESQG collection tank Is soley from DIY and/or CESQG sources.I have not mixed this waste oil 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 provided about this waste is incorrect <br /> (All generators/customers MUST read the following text <br /> I cert!y 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 /> pract cable 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 ndividual signing in the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and d aterfals are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide <br /> by t Standard Terms and Conditions on the reverse side of this Service Order. <br /> Be Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee, e fees cover the EPA pass-through fee and administration <br /> I c <br /> pr <br /> Th <br /> an <br /> by <br /> Se e <br /> d1 y that <br /> nd -d <br /> .t.,Ia <br /> t Stand <br /> Orders <br /> h <br /> m <br /> ua <br /> Is <br /> Standard <br /> rt c a 098a n place t') <br /> This <br /> I.rt <br /> a packaged,reduce th <br /> r disposal <br /> h be[." <br /> aged'' <br /> Terms <br /> n he rave <br /> JS have <br /> r I P' c . w <br /> v p r r m <br /> cable <br /> method of treatment, <br /> 'storage, <br /> I signing <br /> ning in the-pace set <br /> are true and accurate <br /> a.p <br /> d Term and Condition.- <br /> e with an associated <br /> !at:d hazard -waste <br /> s v <br /> h eManifest program. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br /> 0 <br /> ignature Dae DrI <br /> ;�i�vjgnature D to <br /> Pri me <br /> Print Driver Name <br />