Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER <br /> PARLIER • - ,r ASBURY ENVIRONMENTAL SERVICES , DBA FORM NO. WOES004-1) (1 /17) <br /> 559498-0240 WO 250 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: WODIY t R� <br /> 562-231 - 1550 <br /> AF 150 WORLD OIL <br /> ENVIRONMENTAL SERVICES ,M <br /> s14 EAST MANNING AVE, PARLIER CA 93648 <br /> I PREMIER CHRYSLER DODGE JEEP RAM CI - 1 -559-498-0240 <br /> a 3460 NAGI_ FE ROAD WWW,WORLDOILCORP,COM 3460 NAGLEE ROAD <br /> E <br /> ° TRANSPORTER EPA # CAD028277036 <br /> T fRACY , CA 95304 TRACY, CA 95304 <br /> 0 ( 209 ) 820- 1815 (209) 820- 1815 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDERTAKEN BY HALIDES <br /> PRF- 147 ROUTE 110 6lj SCHEDULED-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # <br /> 1 / 17 /2018 1 / 11 /2018 CAL000385003 C)` R3' S2C.3 3 k <br /> PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> WO•SC USED OIL SERVICE CHARGE 1 $ 100 , 00 C' $ 100 . 00 <br /> WO USED OIL / MIXED OILS 200 $0. 00 $ 0400 <br /> BATCH # <br /> Cross Streets : TOTAL <br /> CASH RECD: CHECK # Acoourd Marm&W, Steve Gately <br /> WASTE DISPOSAL INFORMATION <br /> NON- RCRA HAZARDOUS WASTE, LIQUID ( USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID ( ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATETSDF: ASBUR r I ALI ULU rw - i <br /> DRUMS P/U : EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION ( PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> ( Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ^l ) I have not mixed 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. l have compiled with the requirements of <br /> 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 the Information I have provided about this waste is Incorrect <br /> Oa21 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 <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 charges for the dlsposal of this <br /> waste If the Information I have provided about this waste Is incorrect <br /> E= 03) This waste is from a tank which collects waste oil 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 <br /> In my DIY/ CESOG collection tank is soley from DIY and/or CESOG sources. I have not mixed this waste oil with any other hazardous waste or waste oil from other sources. I agree to accept the additional charges for disposal <br /> of this waste if the information I have provided about this waste Is Incorrect <br /> (All generators/ customers MUST read the following text and check the associated box.). <br /> li_) g4) If I am a large quantity generator, I certify that I have a program In place to reduce the v01Y11W and anlcny of w,oste ftenetated to the degree I havr detannlned to be economically practicable and that I have <br /> selected the practicable method of treatment, storage. or dhpoud currenHy nvaBabk to me which minlndms the presem and future threat to human life and the anvironmenU or, if I am a small quantitygral <br /> eneor, I <br /> have made , Ilexif oil eifnii to minimise my waste generation and selecl the heat waste management method that is avaBable tome tint I can afford <br /> This indiv I 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 ( moing descriptions of waste and materials are true and accurate <br /> ap,pa`cka d marked and labeled, are ready for transportation in accordance with applicable state and federal regulations, and that customer shall abidea bound by the Standard Terms and Conditions on the reverse <br /> /nsdeo'fN s rv)ceOrder, <br /> Ak <br /> -usiy6m' % Sign� ture , f7 � Date DriverSlgn tyr Date <br /> Print Na— rn Print ame <br />