Laserfiche WebLink
'POR SERVICE. CALF.: SERVICE ORDER <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, D13A FORM N.O.WOES004-D (1/17) <br /> 559-498-0240 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD IL <br /> r _ ENVIRONMENTAL SERVICES <br /> s 14287 EAST MANNING AVE,PARHER CA 93648 <br /> 1-559-498-0240 <br /> p <br /> E V;JWW.WORLGOILCORPCOM <br /> E <br /> D <br /> T TRANSPORTER EPA#CAD028277036 <br /> e <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> PART# DESCRIPTION CITY UNIT PRICE QTY P/U TOTAL <br /> 1= 4'. <br /> TOTA L <br /> CASHREC'Di CHECK# <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 /> OTHER'= <br /> DESIGNATEDTSDR <br /> ALTERNATE TSDF- --- <br /> DRUMS P/U: EMPTY DRUMS: _ FACILITY!_ BSC <br /> GENERATOR WASTE CERTIFICATION! (PLEASE CHECKTHE APPROPRIATE BOX) <br /> Sy signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> L_ #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 complied with the requirements of <br /> the applicable California used oil management regulations to determine this is true.t agrae to accept the additional charges fof the disposal of this waste if the information I have provided about this waste is incorrect <br /> =#2 I have Pat mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than l poo ppm,and the waste daes nor contain any PCSs.I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumptionthat this waste was mixed with other hazardous waste.l agree to accept the additional charges for the dispcsa;of this <br /> waste if the information t have provided about this waste i s incorrect <br /> M#3)This waste is from a tank which collects waste oil from household"do-it-yourself'olY)and/of conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained <br /> in my DIY/CESQG collection-tank.is Soley from ON 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 disposaf <br /> &this waste if the information I have provided about this waste rs incorrect <br /> (All generators/customers MUST read the following text and cheek the associated box.) <br /> t d4)If lam a large quantity generator,I Certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined robe economically practicable and that I have <br /> si±i¢cted the practicable method of treatment,storage,or disposal currently avaiiable to me which minimizes the present and future threat to human life and the environment;or,if t am a small quantity generator,I <br /> have made a good faith effort to minfmtze my waste generation and select the best waste management method that is available to me that I can afford. <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 descriptions of waste and materials are true and accurate <br /> as packaged,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that.Customer shall abide and be bound by the Standard Terms and Conditions on the reverse <br /> side of this Service Ordec r " <br /> + 1 � <br /> r+ j <br /> Cus�gmer SfgnatLAr Date Driver Sig tacure D t <br /> Print Name Priait Drivers Name - <br />