Laserfiche WebLink
F.OR SEFIVIdE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY EN IRONMENTAL.SERVICES, DBA FORM N0.WOES004-B (4/17) <br /> 1-800-727-2879 WO 650 �. j4 ` SERVICE ORDER NO. _ <br /> FOR ACCOUNTING CALL: WODIY 0. N�51981H , <br /> 562-231-1550 <br /> AF 125 <br /> WORLD OIL <br /> ENVIRONMENTAL .SERVIC.ES,. <br /> H S"1"f�Cl CI-CJN DODGE INC 7300 CHEVRON.WAY,DIXON CA 95620 <br /> P 3333'AUT.0 C JJTER CIRCLE 1-800-727-2879 PO 130X 800 <br /> p WWWWORLDOILCORP.00M <br /> E <br /> STOCICT0N, CA 95212 TRANSPORTER EPA#CAD028277036 STUCKI ON,.CA 8524$ <br /> 0 (09) 417.3668 (209)'477-3668 <br /> CUSTOMER# PURCHASE ORDER A ROUTE# TRUCK It CONTACT NAME ORDER TAKEN BY HA>_IDES <br /> 5TM7 R')UTE 724 SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NExT 5ER .ICE DATE CLISTOMER EPA i' BILL of LADING/MANIFEST q <br /> Z`1 4/2016. 218l2078 cgD987997 {} �, <br /> PART# DESCRIPTION QTY UNIT PRICE' `QTY P%U', -. TOTAL <br /> MSC. USED OIL SERVICE CHARGE 7 $80:00 $80.00 <br /> WO USEQ OIL/MIXED 10IL8r' 380: $0,00 ¢ $0.00 <br /> . T <br /> -C Stu ts: Get signature from Easy. TOTA€. .: ' <br /> CATH RECD;' CHICK(I—. Awe net Nnfya9el;" rlts. a .r. <br /> 1lIIAST <br /> E DISPOSAL INFORMATION <br /> NON-RCRA HAZARDQU5 WASTE,LIQUID(USED OIUMIXFD OILS) STATE CODE 221 1 t <br /> NON-RCRA HAZARDOUS WASTE,LIQUID.(ETHYLENE GLYCOL SQLUTIQNS) STATE CQI]E <br /> OTHER' •- <br /> DESIGNA7EDT5DF: ASf3YfR�`fMHROFIA+IEk7`RI:3E�tVtCE °igS;T9HEOR r ]6#t1Ai.00036�0 <br /> ALTERNATETSDF: <br /> DRUMS P/U: EMPTYDRUMS:_ FACILITY: BSC-- <br /> L <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify,that: <br /> (Waste oil gerleratarlcustol-ner MUST check ONE o€the.foliow�ing three hyflxes} i a. <br /> ' Ierff2fa,��n�t MiNdapv6fthe wa it r dw criimt above wit h Inyu16vr AxXIOo us wastc.thu rural rsande content is L FS5 than),noa Dpm,aid the wa sit;does n cs contal n any os.I have complied with I he leclu,rrmenis of <br /> the appllcpbW Cakfofnla used'oil managcrnent rrguiatlons to desermitte this it uur_I agree taacCept the additional charges far the disposal of this waste illhe lnformatlon l have provided about this waste is Ihcnrrrct" ' <br /> f=s21 have not mleed any of the waste deKtIlied above wish any other hazmdous+wasm.theta:al halide coalent 11 GREAYEit Ihsn J"ppm,and the wasae doe;nottantaln any PC9s.l <br /> .• haat p3pgided proper dvcumentaµom ro Wald t3tl Erlv}roprnenlal SerwrPs,So but Sha prc twmption thal thh wasim_wag nuted with other ha?aidou'Wgy1?l.+rd"To accept,the additional chargrs far the disposal of this <br /> Waltfl If thn inrarirsnllon I have provided nbout this watieii Incouect' <br /> Cis 3)Thii wArte,K from a tank wh lch rol liects wa t Wolf ffwn l+otisuhMd'J�It•yairrsrlf'tDIYl ar W or cmil timsa qy exempt sn+.t[0 rani fly generatsu lC ESM),ou rc m,To me pile of rriy irnoaAriLyv,shh aniy war to dot Cantillnmd- <br /> Irl nybrYlt:1 c&l nfdh¢i'A It salcy irarrl DiY arid/Cr CE5C1G saurcns.I have'FTat frtixedtfiliwatie all with any athmr hvardaus haste ar wsste'oll rrr;m Vlftei source',I agree to a&epT Iltcadd11lnrsal Charges 1{u disposal <br /> of INV Waste N 1Ito fnfrallon t have provided about IWs waue 4 incorrect !� <br /> (AlI generators/customers MUST read the following text and-check the associated-boar) <br /> III 1 am a large quanlllylit neralt'r,I carllfy that I have a prograin In plow io volts-Ifni•vWWneand Torrclsy of was le+�"Wratets to the degree!have doermimrd to becconornkatty pa6ltcable and Ihit 1 have. <br /> "Dekird The ptatiklible rrtathad of Trtatf"nt,ltorat�r,ar'divotal turrentty avadliblt to Ilse Gvhlsh ruinlridtrt she'po-sern.14 fuluie thmil.to human lift and the eWpa,tmeot;Or,If I'thtitx small rluantlty 3011e0to4,I - <br /> have madti a gOeiSfaith rfTtirt lv n+lnrmiau niy niasl .ydneiaVon a6d seldcl the best wbsto mirsagamsemt method that h avaflalirc,to me fel I r m;gfrotd, <br /> 7liis individual signing in the space set forth on behalf of Customer represents and warrants that he/she has the authority to bind Customer,11iat the forgoing descdplionsof waste and materials are true and'accwase• <br /> • as packaged,marked and lnbalocl urc ready Detalioa in accordance with applicable state and federal regulations,and that Customer shall obldw aril Ise bound Waw-,TrrDfaeJ Terms and Candid an the reverse <br /> std f this Service Order. <br /> Custom r Signature Date Driver 5ignatur Date ' <br /> Pr N me Print•Dflvers Name <br />