Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES DBA <br /> 1-800-727-2879 ' SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: ,t'�I����� O�L N`'9/82`�" <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> S 7300 CHEVRON WAY, DIXON,CA 95620 <br /> " ANTONINI EiNTER.P c SES LLC--- I-A i HROP 1.800-727-2879 ANTI ONII°NI ENTERPRISES LLC- A <br /> I <br /> P 701 6,,�1R6,,,PKvV'( WWW.WORLDOILCORP.COM PO PDX&1.66 <br /> E TRANSPORTER EPA#CAD028277036 <br /> i._A T HI OP, CA 35330 S 215 <br /> i20 a}) X93-ciFi95 ( q91 G6F�=;�'r.J.�CI <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> AN T606 'AM RE AID smartinez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> CAL000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> O <br /> 1)R. Ou_ IFIL7 ER DRUM REPL ACL MENT- N0 CHAR"3( .. <br /> OF IJSC D METAL OIL AND GASOLINE F=ILTERS <br /> .101iN?11•. 4fi6-4000 �iATCh!#' <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ . <br /> OTHER: NON-Rr,Wt H.42ARDOUSWASTE, Sol.ID{FILTERS CONTAINING OIL)STATE Cori E-M p <br /> DESIGNATED TSDF: <br /> AVERNATE TSDF: <br /> Gross Streots: ccaun anacgar. , am RI . <br /> DRUMS P/U:_ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIAE B ) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three -o4�)-=!�===:- <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 PCI39.I have <br /> 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 <br /> the Information I have provided about this waste Is Incorrect <br /> Q #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 contaln any PCBs. <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 <br /> charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect <br /> Q 03)This waste Is from a lank whlch collects waste oil from household"do-lt-youraelf"(DIY)andlor conditionally exempt small quantity generator(CESCG)sources.To the best of my <br /> knowledge,the only waste oil contolned In my DIY/CESCG collection tank Is saley from DIY andlor CESCG 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 thrAu <br /> l t d the environment. <br /> This Individual signing In the space set forth below on behalf of customer represents and warrants that he/she has the autust me,that the forgoing descr[ptlons of waste <br /> and moterlala are true and accurate as packaged,marked,and labeltid,oto ready fortronsportntlon In oecordanea with appnd f doral regulations,and Ilial customer shall abide <br /> by the Standard Terms and Conditions on the reverse sldo of this Scrvfcu Order. <br /> Service Orders with an assoclaled haxardot s waste manllest(either site specific or consolidated)are subject to an EPA Feco r the EPA pass-through fee and administration <br /> of ilio eManlfest Program. These fees va ased on Manifest type.Applicable fees will appear on your billing Invoice, <br /> / r a <br /> Cu emer nature Date Dritur Date <br /> 1 <br /> Print Name ► Print Driver Name <br />