COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA 1-800-727-2879 SERVICE ORDER NO. FOR ACCOUNTING CALL: \3155236 562-231-1550 WORLD O I L ENVIRONMENTAL SERVICES, H T I -- I 300 CHEVRON WAY,DIXON,CA 95620 I AN ON N! ENTERPRISES LLC- L, THRrr� 1_800.727-2879 ANT0114INI ENTERPRISES LLC;-AN P 701 D'ARC"!PK"L&rY PO LOX 8468 WWW.WORLDOILCORP.COM D TRANSPORTER EPA#CAD028277036 C�GI� T i..r?T HROP,CA 95330 � ''"'u�7)��93-6695 ST 'i"ON,'CA 95�9 (209) 486-4900' CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ANT608. i s:OU I E 12, 4001 JOHN SGFIEDLILEID--I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 22/10/2020 2/4/2020 CAL000325703 \ PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 'AfC•UC USED OIL SERVICE CHARGE 1 VV0 USED OIL/ !�JIIXED OILS 176 JOHN 2.,?-566-:5900 BATCH;� _ 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:_ nS80Y EfdVIrNF�EidTAL S ^nVlC�S C'E #S, 1920 ili�7RG,4id 1:u._CEFES CA 9ssa f�tra) ?1-i�? ,C4L000393850 ALTERNATE TSDF: Cross 5Ca coeis: Account fiGana er:,Sam Rc-ad , DRUMS PN: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BO'X' By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three.rb xe , 7p1 �ryry 511]1 have not mixed any of the waste described abavo with any other hazardous waste,tits total halide content Is LESS than 1,000 ppm,and the waste cluesri nt contain any PCs.[tj� 1 Il compiled with tho tequtromenls of f Ite appllcabie celtforala used oil management regulations to detarmfne this Is true.I agree to accept the addltlonal charges for the disposal of this waste if ++j the informal Ion I have provided about this waste Is Incorrect q2 I 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 not cYantal an nyr•pCBs.t 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 adallfanal: charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect «.f (j n)This waste Is tram a tank which collects waste oil from household"do-It-yddrself"(DIY)and/or conditionally exempt small quantity ganuralor(CESCIG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG collection tank Is Soley from D1Y andlor CESOG sources.I have not mixed this waste oll with any olhar hazardous waste or waste oil from other sources.I agree to accept the addltlonsl charges for disposal of this waste II the Information I have provided about this waste Is Incorrect (All generators/customers MUST,read the following text I certify that I have a proarnm In place to reduce the volume and tuxiclty of waste genw4led to the degree I have dolormined to be economically practicable and that I have selected the practicable method of treatment,storage,or dlsposal currently avaliable tome which m[nimlzes the present and future,threat to human life and the environment. This Individual signing in the space set forth below on behalf of customer represents and warrants that helshe has the authority to bind customer,that the forgoing descripllons of waste and materials are inin and accurate as packaged,marked,and labeled,aro ready for Iraneportatlon In accordance with applicable state and federal rogulatlons,and that customer shall abide by the Standard Terms and Conditions on the reverse side of this Service Order. Service Orders with an assacl a hd rdous waste manifest(either site specific or consolidated)are sui,leat to an EPA Fee.These fees cover the EPA pass-through fee and administration of the eManlfe. ogram. Th to vary based on Manifest type. Applicable fees will appear on your billing Invoice. ,^ kCult or Signs05G Date Driver Ignature Date, 1 Print Name Print Driver Name