Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER <br /> FORM NO.WOES004-13(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: N3373261 <br /> 562-231-1550 } WORLD OIL, <br /> ENVIRONMENTAL SERVICES» <br /> H ANTONINI ENTERPRISES LLC- LATHROf Soo CHEVRON WAY, CA 95620 <br /> I 1-800-727-2879 ANTONINI ENTERPRISES LLC-ANTC <br /> E 70.1 D'ARCY PKWY WWW.WORLbOILCORP.COM PO BOX 8468 <br /> D LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 r <br /> T STOCKTON, CA 95215 <br /> o (209) 993-8695 (209) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN1608 CER-88 �/A/ JOHN SCHEDULED-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 1002020 9/2312020 CAL000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 2 <br /> PF PAPER FILTERS PER DRUM 2 <br /> JOHN 2C.3-466-4900 BATCH, <br /> TOTAL <br /> CASH REC'D: CHECK# <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:, NON-RC SkAZARDO(�S]I4 ASTF,SOLID[OILY PAPERIELAST)C FILTERS I DERRI51 SftitaCcidp.352 - <br /> DESIGNATED TSDF: YES MANAGEMENT,INC.,6500 US HIGHWAY 95,YUM_A_,AZ 95365 <br /> ALTERNATE TSDF:LJ <br /> GrCss Al=unt Manager: San Read <br /> DRUMS P/U.(,/ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q #1)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 <br /> complied 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 <br /> the Information I have provided about this waste Is Incorrect <br /> d #21 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 Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.l agree to accept the additional <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> 0 43)This waste Is from a tank which collects waste oil from household"do-Il-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESOG collection tank Is soioy from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> 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 <br /> (All generators/customers MUST read the following text <br /> I certify that I 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 <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human Ilia and the environment. <br /> This hidIv ual signing In the space sat forth below on behalf of customer represents and warrants that 11E.rstie has the euthorlly to bind cuslomer,that the forgoing descriptions of waste <br /> and ritaw Is are true and accurate as packaged,marked,and labeled,are ready foriranapodatlon In aecordnnco Mill applicable stale and federal regulations,and Thal customer shall abide <br /> by theSt idard Terms and Condltlons on the reverse side of thls Service Order. <br /> Seryl riots than associated hazardous waste manliest(either site specific or consolidated)are sublet!loan EPA Fee.Thea fees cover the EPA pass-through fee and administration <br /> e e o rifest p gram. These fees vary based on Manifest type, Applicable fees will appear on your hl)Iing Invoice. <br /> �11_svbnir 5' nature �( Date riv r Signature Date �J <br />