Laserfiche WebLink
ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES002-B (5118) <br /> FOR SERVICE CALL: <br /> DIXON SERVICE ORDER <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: NO. w' <br /> 562-')31-1550 WORLD OIL © 1Y <br /> 7300 CHEVRON WAY DIXON, CALIFORNIA 95620 (800)727-2879 <br /> EPA#CAD028277036 <br /> Date Customer# <br /> Customer EPA# <br /> Address Commodity <br /> City State Zip Halides PPM <br /> Phone Contact Amount <br /> Cash ❑ Check# <br /> Notes: <br /> Waste Disposal Information <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> ❑ NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(OILY WATER)STATE CODE 135 <br /> ❑ OTHER___ <br /> MANIFEST# <br /> NEXT SVC DATE DRUM SIZE QUANTITY TRUCK NUMBER <br /> _-.,-SIGNATED TSDF: <br /> ❑ WORLD OIL RECYCLING"2000 N.ALAMEDA STREET'COMPTON,CA 90222`CAT080013352"(310)537-7100 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES.2549 SCOTT AVENUE"CHICO,CA 95928 x CAL000827844`(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-CHICO II, LLC' 1618 W.5TH STREET'CHICO.CA 95928.CAD980694103-(800)733-9043 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES-FORTUNA'200 DINSMORE DRIVE' FORTUNA,CA 95540'CAL930256136"(80C)733-9043 <br /> t <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES'7300 CHEVRON WAY" DIXON,CA 95620"CAT080012602-(707)693-6008 <br /> ❑ YUMA YES LLC' 2730 E. 13TH STREET, YUMA,AZ 85365'AZR000515924,(928)643-6938 <br /> ❑ RAMOS ENVIROMENTAL-1515 S. RIVER ROAD"W.SACRAMENTO, CA 95691 -CAD044003556-(916)371-5747 <br /> ❑ WORLD OIL ENVIROMENTAL SERVICES" 1920 MORGAN RD,STE AES'CERES,CA 95358"CALOOC393680-(209)541-1825 <br /> ❑ BAKERSFIELD TRANSFER INC.' 1620 BRUNDAGE LANE' BAKERSFIELD,CA 93307`CAL000282598`(661)377-0308 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC' 14287 E.MANNING AVE' PARLIER,CA 93648'CAL000102751 '(559)498-0240 <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 /> (❑at)t have not mixed any of the waste desenbed on the service order noted 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 complied with the requirements <br /> of the applicable California used oil management regulations to determine this is true,I agree to accept the additional charges torihe disposal of this waste if the information I have provided about this waste is incorrect, <br /> (❑42)l have not mixed any of the waste described on the service order noted above with any other hazardous waste,the total helido content is GREATER than 1.000 ppm.and the waste does not contain any PCBs.I have provided proper documentation <br /> to World Ca Environmental S—ces to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect. <br /> (0*)This waste is from a tnnk which coflects waste of item household"do-it-yourself'{DIY)anther conditionally exempt small quantity generator(CESCG)sources.To the bast of my knowledge,the only waste Oil contained in my 61WCESOG <br /> collection tank is solely from BIY/CESQG sources,111-1-not mined this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additicra€charges ter disposal of this waste if the information I have provided about <br /> this waste is incorrect. <br /> (Ali 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 havo determined to be economically practicable and that i have selected the practicable methed of <br /> treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and 1116 envlremnen€. <br /> This individual 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 description of waste and materials are true and accurate as packaged,marked and <br /> , are ready for transportation in accordance with applicable state and federal regulations and that Customer shall abide and be bound by Iha Standard Terms and Conditions on the reverse side of this Service Order. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />