COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERWO'ES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: WOR '. ,. art,;,"* f;•� 562-231-1550 0 ■!!f O R `1 h {{,�,,s• ENVIRONMENTAL SL'RVICES.- S 7300 CHEVRON WAY,DIXON,CA 95620 H t'.�7 �.l�til..f:'':�<.:�� ..,,1'!f I?� ,. �; 1-800-727-2879 P P ':'•,i')fNi WWW.WORLDOILCORP.COM E TRANSPORTER EPA#CAD028277036 T i! ;s fIr�°i,i:: r;,y . p CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES 11 > ;�•II' I ' LI !'. . t , . .s DATE REQUIRED DATE ENTERED NEXT SERV! E CUSTOMER EPA# BILL of LADINGI MANIFEST# .�I::I .�.?('•. .. :�,�-+lit=:�.;=Frit' . . f 7 4 ' PART# DESCRIPTION OTY UNIT PRICE QTY PIU TOTAL vey_ I ..'P. .v4:'L'..:1 i':.11•1�Y :,'.! ;1`.,'�f'.'• ��"s ;'^ .'.vii i;%'r TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS.WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: ;.a. . DRUMS PILI: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below 1 hereby certify that: ' (Waste oil generator/customer MUST check ONE of the following three boxes) 01)1 have not mixed any o1 the waste described above with any other hazardous waste,the total halldo content Is LESS then 1,0D0 ppm,and the waste does not contain any PCBs,l have compiled with the requirements of the applicable Catlfomla used oll management regulations to determine thlo is true,l agree to accept the addhional charges(or the disposal of this waste If the Information I have provided about this waste to incorrect [] 021 have not mixed any of Iho waste described above with any other hazardous waste,the totall halide content Is.GREATER than 1,000 ppm,and the waste does not contain any PCBs.1 have provided proper documentation to World Oil Environmental Services to rebut the presumption that thts waste was mixed with other hazardous waste.t agree to accept the additional charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect 0 03)ThIs waste in from a tank which collects waste oll from household"do-It-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESGG collection tank la soley from DIY and/or CESGG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.1 agree to accept the additional charges for disposal of this weals It the Information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text I certify that f 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 I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment. Thla Indlviduat signing In the space set forth below on behalf of customer represents and warrents that helshe has the autho►i1y to hind cuatemor,that the forgoing deocrlplions of waste and materials are true and accurate as packaged,marked,and labeled,are ready for transportation In accord once with epplltahle state arid federal regulations,and the!custpmar shall abide by the Standard Terms and Conditions on the reverse side of this Service Order. Service Orders with an associated hazardous waste manllest[either Bite apecfflc or consolidated]are subject to an EPA Fee.. These fees cover the EPA pass-through fee and ad ell ntstration of the eMan ifedt pram. These fees vary basad on Manifest type.Appl=tc.fees wilf appear on your billing Invoice. •. Customer Signature Date l;ri r"Slgnature Date Print Name Print Driver Name