COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

F0nSERVICE.f;A1-L: SERVICE ORDER FORM NO.WOES00,4-13(8/18) DIXON UFFICE AS URY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 aa SERVICE ORDER NO. FOR ACCOUNTING CALL: N2713092 562-231-1550 4 "11 O L D �i■ .- y ENVIRONMENTAL SERVICES u S 7300 CHEVRON WAY,DIXON;CA 95620 H STOCKTON DODGE ING 1-8,00-727-2879 P 333.3 AUTO 'CENTER CIRCLE PO Box 8009 E WWW.WORLDOILCORRCOM- D TRANSPORTER EPA J/"CAD.0282770.36 STOCKTON,GA 65212 STOCKTON, CA 95208 T (,209)477-3668 (209)477-388$ CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN. HALIDES ER-8.8 S DATE REQUIRED DATE ENTERED NEXT SERVICE DATE.. CUSTOMER'EPA# BILL of LADING/MANIFEST# 10/25/201a CA 1798 1 OB7680 O 1, ') ca.8-8vz A P >r C IP7 0 .QTY UNI PRICE' QTY PIU OTAL f EMS EMANIFEST EPA FEE'S ADMIN-SITEr-SPECIFIC MANIFE I $i acro / $10;00 65•0/T 55 GALLON 6-ftDRUM REGONDIT`1OIVEI� � 1' $b2.00 / $52.00 BATCH Al `ti - TarAL A$H.REC'P-- CI4ECIC . WASTE DISPOSA INFORMATION• NON-RCRA HAZARDOUS.WAST�,i(QUID(USED Olk_(MIXEp'O1L'Sj . ',',; STATE CODE 221. NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) -" -STATE CODE.' OTHER: _ DESIGNATED TSDP:ALTERNATE TSDFa --_ _- 11�ti�i�f(Si AcaaunC Meerf fir.Todd'Aile t _ DRUMS P/U: O EMPTY DRUMS: FACILITY: BSC. GENERATOR.WASTE.CERTIFICATION'(PL&S' E dfiE,CK.THEAPPROPRIATE.I3,OX) By sllgning below I harcby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) L if)I have not mixod any Df file waste deacflbed above With Any other hazardous waste,the local halide content ISLESS tbrin 1,00 ppm,and thewoala does riot contain a,iv PCBs.I have eom�Acd wish the requiromonte of the nppifcoble Collfornla used oil managanienl repulot fono to dotormino shin Is lrpo.I agree 10 Accept adttlfloiml ohargos lot tho dtopesarof thlswaste II the Inlormntion 1 have provfded.about thin wnato Is Incorrect 0 b21 have not mlxed 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 Peas.I have provided propor documentation to World Gll Envlronmentet SaFvlcaa.le rebut tha proaurnplion that this waste was mixed with other hazardous weata.l agree to aeanpttha additional chbrges for the dlspoaal of this waste If the inlormdtion I have provided about this waste in Incorrect Thlawaale Is from 1;tonk which eoltaota waste oil From houaohold-dill-youfaelf"{DIY]pndfor canditlortally oxamptatitatl'quentltll.panarelor ICESOG)saurdos.To the best of my' knowladg%the onlywaate oil cornatnod 1n Any MICESOG collection intik la so!ay lrbrn OTY and/or CESDarsourcmt.IAavis net rt um 11 if waal4 pllwfth any attain h aYuiHon i waste or waste oil Irorri other aaurcaa.l norm to occupl Iho addition at cltargoa for dlapps at'of thin waatn 11 tho'InfoimnffaA I have pfovlded about Ihls wears la incorrect (All generators/customers MUST read the following text I cortlly that I have a program In place to reduce the volume and toxicity of waste generated le thu degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently avallebie:to me which minimizes the preaant and future threat to human life and the envlronment. , This Individual algning In'he apace rut Forilr bowwon Aehall at cuatomer reprenantn and warrantn that he/she frail Ihaauthorily to-bind customer,Ihnt the Imgoing descriptidns of waste. and millarlaie are sass pad acCureta,ea packaged,markad;and labolad,ore ready for Iranoporwilon In Accordance with appllcablo state And fodaral rogufal4,ns-and that customer shall ablde by the Standard -n and Cohdillons on she ravorse Aida of this SArvlea Onler. Sarvlc Aa i ocialod hA:nrdeun waato manlfoot(either site 9pcclflc or consolidated)are eublecI to an EPA Fee. r to Cee EPA pass-through fee and administration vi the nn a t n These Inon vary based on Manliest type. Applicable fees will appear on yatlr billing Invoice. Custo er Signature Date river Signature .,Dale Print Name Print Driver(dame