Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER! <br /> I 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: 9457 <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICESrM <br /> s 7300 CHEVRON WAY, DIXON,CA 95620' <br /> " {�II`lE� 14;)f�II�i/:6 `I 2 1-80o-�2�-2879 t��ti.ES'i 1��,4�CYtJ{aCb�M��i�diT I'1R4 e <br /> P 940 Nd t...�:f�1��6�I~�f�I..,AVE, WWW.WORLDOILCORP.COM 175 MAIN TI FET, t.11"����?i� <br /> R <br /> E TRANSPORTER EPA#CAD028277036 <br /> � Y, >A � �l T F 0, 'TX 7,30;34 <br /> 0 OR) 221 04 (972)464-0004 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# J TRUCK# CONTACT NAME ORDER TAKEN i3Y HALIDES ( <br /> , 1. <br /> 14, a" <br /> R < OU R/ �CS -ED InED i <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE. CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 1118.120 18 10/3'i/'2018 CAt.,0()0370 9@ <br /> PART# DESCRIPTION OTY UNIT PRICE CITY P/U TOTAL 4 <br /> Vf (,J,5(,; 05GE1 TT.S 'iia C,T 'c"r7. <br /> 1 ,50 <br /> l <br /> (WEN IW-'7..7PM 7••6P1Vf SUN 0-51AM BATCH# .,. .. :.._,,....� ). <br /> TOTAL <br /> CASH REC'D: CHECK# i <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: <br /> DESIGNATED TSDF: I Nt xlyY FI1i/iRC+NMF�NTAI Si R\I`ICE3�''k RE$, 102 3 Ma RG"�AN RM,C,. Q (? ) <br /> FF�F CA 8'b3i9 diff i 'i 1023 ^/8t0i10 €t0 <br /> ALTERNATE TSDF: <br /> Av austt Mamt gw:Todd Audi <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC I <br /> GENERA,TOR 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 /> 50#1)1 have not mined 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 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.aboutthis waste is incorrect { <br /> Q #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 PCBs.I 1 <br /> have provided proper documentation to World 011 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 /> Q #3)This waste Is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionallyexempt small quantity generator(CESGIG)sources.To the best of my <br /> knowledge,the only waste oll contalned.in my DIY/CESQG collection tank is soley from DIY and/or CESQG sources.l 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 MIDST 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 economically practicable and 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 /> 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 <br /> and materials are true and accurate as Poo kaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations ancf,thpt customer shall abide <br /> by the 5tafidard Terms and Conditions on the reverse side of this Service Order. <br /> SeVvice Orders with an associated he ar#o�s waste}nanifest(either site specific or consolidated)are subjectto an EPA Fee. These fees cover the A pass through fee and administration <br /> �8f tfte eManite;t program. TIie4-19&&vary�sed on Manifest type. Applicable fees will appear on your billing invoice. ? <br /> CustPrner Signature ,- Date Driver Si na urs s D to <br /> f <br /> G <br /> Of LIA <br /> Print Name Prie tie <br />