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 SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: NN34,82197562-231-1 �550 )WoIZLD OIL ENVIRONMENTAL SERVICES„'" 7300 CHEVRON WAY,DIXON,CA 95620 H AIDE T ONINI ENTERPRISES LLC- LATHRO 1-800-727-2£379 ANT 01''\,1I1\!1 ENTERPRISES LLC-AN P 701 D'ARCY Flirt' PO BOX r:468 P WWW.WORLDOILCORP.COM oTRANSPORTER EPA#CAD028277036 T LAT O�,wA 9 ,� c S)TOCKTON, CA 05215 0 (2oo) 993-8695 (09) 4«-4900 CUSTOMER# PURCHASE ORDER# ROUTE# TRRyUCK# CONTACT NAME ORDER TAKEN BY HALIDES k'!N f 0-u-0 I 1tUU i— •'i 21, lUh !\� :a(:i7f;1,1ULk:U-I DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 3/4/2u20 cALocJc3J; Q3 � • 3 I I�l JJIz PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL VV I U ;) UIL (•;IHAf t(5[_ � VVn USED OIL OILS 315 JOHN 2t •466.40.00 BATCH fit. TOTAL CASH REC'D: CHECK# 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: ' ' DESIGNATED TSDF: �.ii31J't��'inN[riR[] 1,4r i�TAL 5Enti1�lCEti•CE#�ES, ')9?0 iVfyl��r�dv F:D., EftFS,vA 0.53ae�(?[7:r)5Y'i-1825,CALtl017393f0Q 'Fs J. ALTERNATE TSDF: __ __ - ::rr,,ss GsE G"; A t v o p n t I V11, sy yTtpd� ' � ` DRUMS P/U: EMPTY DRUMS:_ FACILITY: BSC _ 1.4 GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROP IIA E BOX) By signing below I hereby certify than (Waste oil generator/customer MUST check ONE of the following the AA'etoxe �1 Vol)I have not mixed any of The waste desormed above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste duos not contain any PCBs.l have complied with the raquirements of the applicable California used all management regulations 10 determine this Is Ifue.I agree to accept the additional charges for the dlspcsal of this waste If the Information I have provided about this waste is incorrect 0 #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,end 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 Q #3)This waste Is from a tank which collects waste all 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 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 oll 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 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 practicable method of treatment,storage,or disposal currently available to me which.minimizes the present and future threat to human life and the environment. This Indlvldual signing In the apace'sat forth bciaw an beha)f of customer represents and warrants ttnl hdaho has the authority to bind customer,that the torgaing descriptions of waste and materiels are true and aecurale as packaged,marked,and Inbelod,are ready for transportation In accordanco with applicable stale and federal regulations,and that customer shall abide by the Standard Terms and Condilie ns on the reverse side of this Service Order. Service Orders with an assooNled hazardous wasto manifest(either site Specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration of the 4p fest fn green.Th lees vary based on Manifest type, Appllcnhle fees will appear on your billing Invoice. Custopler Signature Date river Signature Date W lv/ &'j/k 1, — — -. J1 Print Mama Print r)dirpr Wimp