|
FOR SERVICE CALL: SERVICE'ORDER
<br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DSA FORM No.WOES004-D (1/17)
<br /> 5591-498-0240 WO 65E1 SERVICE ORDER NO.
<br /> FOR ACCOUNTING CALL: '
<br /> .10
<br /> 562''-231=1550 'WODIY O .,-
<br /> AF 125 " WORLD ®IL
<br /> ENVIRONMENTAL SERVICES,.
<br /> 5 14287 EAST MANNING AVE;PARLIER CA 93648
<br /> STOCKTON DODGE INC 1-559-4W02-40P 3335 AUTO)CENTER QRCL5 w1NW.WORLDOiI CORF?cOlvl PO BOX 8009.
<br /> F,
<br /> T STOCKTO)N,CA 95212 TRANSPORTER EPA-.,#CAD028277036 STOCKTON, CA 95208
<br /> ° (209)477-3M.8 (20)477.3688
<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRLJC # CONTACT NAME ORDER TAKEN BY HALIDES
<br /> $TU627 R )LITE 124. ., SCHEDLILEW
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE:DATE CUSTOMER EPA fI BILL of LADING/MANIFEST N
<br /> 1/22120 18 1-15/201 S. CA00819879$0 10/4 Z 3 (.(,,5� ,
<br /> PART'*' DESCRIPTION QTY OMIT PRICE „.QTY P/U TOTAL
<br /> WQSC ' $lwD.:C71J ; f Vi � HAF�t3E.:;• • t 8000 $80.00
<br /> WO' USED 010 MIXED OILS,--,. , ' 330 $0=. $0.00
<br /> .,t.r ..r... �.i�. i• ,r.. .. •mor.. -IV. z i - -
<br /> C":C=;7 crr.t TOTAL
<br /> :CHEr
<br /> Account Manager Steve Caaty
<br /> �V/6'11 DiSPOSALit FORMAtION
<br /> NON-RCRAHAZARDOUS WASTE,✓-I.QUIf)(USED.UIWy'I I!L)UIL5) STX CODE.221"
<br /> NON-RCRA HAZARD.OUS:WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> OTHEP:
<br /> DESIGNACED i]L]F: ,t I: ,.,. -: .. - M-7
<br /> ALTERNATETSDF: AS RVJ E ' 19M W
<br /> . . m [FaIF•1 wz,
<br /> f'•I?t.l,%".E it 1: EMPTYDRUMS: FACILIT,r: BSC
<br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIAWE BOX)
<br /> By signing below I hereby certify than.
<br /> (Waste oil,generator/customer MUST check ONE of the following three boxes)
<br /> 1) IWmWai
<br /> mlwil airy of the waste drscr6ed abv' thar+yoshee tioxdrdatis waste,the Soul tulkfC CAi+Sr;nL istiE3S shin 1,9fq pprq,an+r mhe waste due+isol copilot--any PCBs.1 have compiled with the requlferrutrits of _
<br /> theafrniausedoilmsgr9emenricVulallans.todeterminathisItlipe.IAlveetoacceptlh�ashJ501110chuge1lnthedls{wsa1of11J6vrAsicifthelnfwinasWnlliaveprovidedaboutthiswasteItInrArrcct
<br /> =1421 have no Mice!my of the wa st it delcrlhod•abwe vrtl IN any othet hazardous waste,tho total halide content it GREATER Ihan 1.000 pprn,11 DO the waue does not contain any Kitt,I
<br /> h 4 prmrldgd pmfrcr dgcstmeTiiatipn to Wor14 Oil E.rffkgagcntal SLry'es iv.rebo)Iho prerurnpdon that thlq wash wlss mixed with other f+twai tde try waste-I AryCFO la ac[elrt the add/rional 1hargts for the.dhpos at of this.:
<br /> wnstn!l thz infmrnailonl•hayr prmldcd"abou l l his wWr fs.lncipccl;,. r
<br /> rja]s IN!,waspe Is from a Lzrt.%010k calkers wash oil from hqusrhnW Srll,y at-self°Ip1Yy anrllru coPtdil10 n Illy exempt smail.quitslary generator{CESaG)sour[es.Tc Ihr Ccst of rnyknowkdge,the enlf+wasly al6fitaln ed
<br /> in my ON)dSAG iulleclwri tank ii suli•y born[NY arrdrdi C606sovpces:l hive nql nslxed this wale ol!oath any al Ncr frarattfoui w55lt.or waste oil frons other snurcos.I agirr Iv accept the aJet!rignal charges(or disppsal '
<br /> of this waste if the information I have provided about this waste Is Incorrect
<br /> "J\
<br /> (All generators/customers MUST read the foiiowing text and check the associated box.)
<br /> d}' n'I,larrfvtln•sQ01W.Ml>»,I,,ertiry rl snt I have a prrynm Inplace to rtdu[o Sha volume and LaWkY ofwaste Wnewlcd to the degree I have dctermin+d to be econ,nmi;�t1IV pmctrcahlp and the;l have,
<br /> r.""ciil�lie-smell"ii,.;melhod of ireatttient-:iura}r,or dlfpos I can htly availuble to for whfch'n+l W MIX6,the plPfenT acrd fuliira lhiidat(d hudtzin Ifrand the ehritonmesil:or,if Iirn a small quantlly generate!,l
<br /> moipu r a good ra,th rilort to min pt0f:tri i wa+sc gnhrialid4 ant(wr:Lt Ilic t>.•x sv'asiq rnanagerncni mrd hod lb-it It avAilable io#Wihit i can WierA
<br /> ., •i -
<br /> flit lodindual swjning In it space set forth below on behalf of Customer represents and warrants that he/she has the authority tobind Cvsin r,dtai the prgdut}drsenplions of waste and materials are Irue and accurate
<br /> as packaged,marked and labeled,are ready for transportation In accordance whWippllcable state and federal regptadon,%and that Cusco shall ahhle rsd tie bound by the Standard Toims and Conditions on the mwine
<br /> 1 side oUhis Srrvicr Order.
<br /> f_,Uint
<br /> stomer5ignatUreg e IgnmureJ-1- yName Print Drivers Name
<br />
|