Laserfiche WebLink
F011A SE VICE CALL : SERVICE ORDER FORM NO . WOES00 .4 - 6 ( 8118 ) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA SERVICE ORDER NO. <br /> 1 -500-727-2879 <br /> t131tG11ii <br /> FOR ACCOUNTING CALL : WORLD OIL <br /> 562-231 - 1550 <br /> ENVIRONMENTAL SERVICES <br /> S 7300 CHEVRON WAY, DIXON , CA 95620 <br /> II TRACY TOYOTA - NORTH NAGLEE RD 1 - 800 -727-2879 <br /> P 1895 NORTH NAGLEE ROA[ WWW. WORLDOILCORRCOM � - " 5 NORTH NAGLEE R0,1f_ ) <br /> E TRANSPORTER EPA # CAD028277036 <br /> T TRACY , CA 9530A TRACY , CA 95 TRANSPORTER <br /> 0 ( 209 ) 834 - 1111 ( 209) 83A- 1111 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> T RA078 MUST OW AIN CERA 66 t�� ! : I . f4) lid <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MAtNIFEST # <br /> CAR000073585 <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U7TOTTAL00 <br /> 0 . 00 <br /> FjR PAPF., R FILTi RS PER DRUM i :� C�. UU /cOILY ! 3 tOILY SOLIDS PER DRUM $&O OU 46 <br /> 5J• Off A 55 GALLON O/T DRUN-1 ( RECONDITIONED) t $5? . Ofj /OI' DR SOIL FILTER DRUM REPLACENIENT & NO CHARGE `✓ $0* 00 _r . 1 <br /> PLS MA COPIES OF fiERVICE ORDER Q SITEII Ot11y laevo 3 replacements en Sen -INN ad fi OMMdr ret' pts s* ng rTn TOTAL <br /> dlftflny TCH # _ <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 : ;194*GRA Zi RPM 19 W48TCLem EPOLID (OILY `" " '`C. _ r <br /> DESIGNATED TSDF : I ` f T <br /> ALTERNATE TSDF : <br /> ,, r011 A ea tr,r Nina A <br /> ChaNITS1DRUMS P/U : EMPTY DRUMS : FACILITY: BSC <br /> } <br /> GENERATOR WASTE CERTIFICATION ( PLEASE CHECK THE APPROPRIATE BOX) e <br /> i <br /> By signing below 1 hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 #i ) 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 /> compiled with the requirements of the applicable California used all management regulations to determine this Is true. I agree to accept the additional charges for the disposal of this waste If 11 <br /> the Information I have provided about this waste Is Incorrect <br /> p #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 Pces. 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 weals IN Incorrect <br /> lly <br /> xempt <br /> G) Source To <br /> t Of <br /> k wl This waste Is from a tank which collects ID Y�CESOG collection tankte nit from household dIs soloy from DIV V) andlar and/or CESOG sources• I have notsmall <br /> m mixed this waste oil with any other hazardous waste orwasteoil <br /> knowledge, the only waste oil contaiaccept <br /> the <br /> in a my <br /> from other saurcrs. l agree to accept ho addltlonal charges for disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> (ATI 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 have determined to be economfcally practicable end that 1 have selected the <br /> Practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> to <br /> nd <br /> that the <br /> tions of waste <br /> aThis nd materllaita aretrue in the <br /> accurate as packaged, ma kedhenf d lebetedcustomare <br /> reer ady for Ira transportation fn accordance with applicaat he/she has the ble state and federand warrantsal regulations, and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest (Minersitespecific <br /> or or will appear consolidated) are sub your b act t nan EPA Fee. These fees cover the EPA pass-Through fee and administration <br /> of the eManifest program. These fees vary based on Manifest typ • pp PP <br /> 04 <br /> ' = <br /> Customer Signature Date Driver Signature Date <br /> / ` print Driver Name <br /> Print Name <br />