COMPLIANCE INFO_2018 - Laserfiche WebLink

Home Browse Search

FOR.SERVICE CALL: SERVICE ORDER PARLIE.rII ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO, WOES004-D (1 /17) 559-498- 0240 WO 250 SERVICE ORDER NO, FOR ACCOUNTING CALL: WODIY N2487730 562-2314550 AF 150 WORLD OIL ENVIRONMENTAL SERVICESm H PREMIER CHRYSLER DODGE .JEEP RA4fOF: EAST MANNING AVE, PARLIER CA 93648 P 34811 NAGLEE ROAD 1 559 198 0240 3460 NAGLEE ROAD P WWW,WORLDOILOORP. COM E TRACY, CA 95304 TRANSPORTER EPA # CAD028277036 TRACY, CA 95304 T (209) 820- 1815 (209) 820- 1815 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES PRF147 ER_ 86 DAVID $Velazquez DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST # 12/ 12/2017 CAL000385W3 PART # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL OFDR OIL FILTER DRUM REPLACEMENT - NO CHARGE 1 $0 , 00 $ 0 . 00 F LISEP METAL OIL AND Gi. SOLINE: FILTERS 1 $ 55. 00 $ 55. 00 IV � O �4 Ori'' l' ly BATCH # Cro 5s Stmets : TOTAL CASH RECD: CHECK #. Acoaunt Manager: Steve Gately WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID ( USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: NCiN. R : RA 1 AZAR00L1S WASTE SCILIU (FI *EFR9 =4TAININ a all) STA'1 Y= l 23 DESIGNATED TSDF: _ ALTERNATE TSDF: DRUMS P/U: EMPTY DRUMS: FACILITY:_ BSC GENERATOR WASTE CERTIFICATION ( PLEASE CHECK THE APPROPRIATE BOX) BysIgnIng below I hereby certify that: ( Waste oil generator/customer MUST check ONE of the following three boxes) OAl ) 1 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. I have compiled with the requirements of 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 Oaz 1 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 have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect OA3) This waste Is from a tank which collects waste all from household 'do•it•yourself' (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my knowledge, the only waste oil contained I in my ON CESQG collection tank Is coley from DIY and/or CESQG sources. l 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 of this waste if the information I have provided about this waste Is Incorrect (All generators/ customers MUST read the following text and check the associated box .) 4) If I am a 14#g* quantity generatof, I certify that I have a program In place to reduce the volume and toxicity of waste geoetatcvl to the degree I have detetminiA to be econontually practicable and that I have selected the pracorable method of treatment, storage,or disposal currently avallnble to rix which minkirtzes the piesanl and future threat to human life and the environment; Or, if r am a small quantity generator, I ve made a good fardr efftnt to minimire my waste generation and selact the best waste management method that Is avallaWe to me that 1 can afford- Th This individual signing In the space act forth below on behalf of Ctntomel represents and warnnts that helshe has the authoitty to bind Customer, that the forgoing descnptinns of taste and materials are true and accurate as packaged, marked and labeled, are ready for transportation in accordance with applicable state And federal regulations, and that Customer shah abide and be bound by the Standard Teams and Conditions on the reverse side thlt Service Order. C# ome Signature I / Date Driver 51 4ature Date Print Name Print Drivers Name