Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-6(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES; DBA SERVICE ORDER NO. <br /> 1-800.727-2879 <br /> FOR ACCOUNTING CALL: N3295344 <br /> 562-231-1550 �'VIIIORLD OIL <br /> ENVIRONMENTAL SERVICES,• " <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> " ANT.'_,NINI ENT&rti!=RISES LLC - LATHROP 1-800-727-2879 ANTONIN1-E'!T FRRRISES LLC-ANT <br /> P 70.1 r-TARCY P11-4, VY WWW.W6RLDOILCORP.COM PO BOX 8468 <br /> E TRANSPORTER EPA#CAD028277036 <br /> T LA, HROP,CF5331 STOGKIC7N, CA 95215 <br /> ° (209) 993-S69S <br /> (203) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT 603 1 (DUTE 12, �Q�� JOHN SCHEDULED-1 <br /> (DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 7/17i2020 713/2021 CAL00036571013 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> VVOSC USED OIL SERVICE CHARGE 1 <br /> wo USED OIL t(MIXED OILS 270 � <br /> JGrN ry;:' �f�a-49G�u BATCH:''' <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NOWRCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF': �s.aFS!)stir r_ trF2c�;�4lI /!Ts �R1Ili, z-fi��'F. f 470-lf~r7F;C�CsPIf rT] CFI2FS {'A. fir iFl fJI] l i4•!-t7?5 .^.�,l.f!i7n i ? 5} <br /> ALTERNATE TSDF: <br /> Account Nlanaacr: Sera Read <br /> DRUMS P/U: EMPTY-DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> :Ell Ingabelow I hereby certify!flat:(Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 17)I not mlxad any of the waste desorlbad abova with any other hazarelorxv waste,the total halide content Is LESS than 1,000 ppm,and the waste does not contain any PCBs,I have <br /> calnpilod wllh the requirements of tho applloable Callfornla used oil managomant ragulaltons to determine this Is true.I agree to aocepi.[lie addillonal charges for the dhiposat of this waste If <br /> the Information I have provldod about this waste is Inoorraat <br /> ❑#21 have not mixed any of the waste described above with any other hazardous waste,the mist halide content Is GREATER than 1,Cpg ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World 011 Environmental Services to rebut the presumption that lhEs 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 /> ❑#3)This waste Is from a tank which collects waste'oil from household"do-Et-yowaolf"(131Y)and/or conditionally exampt small quantity genorator(CF80G)'sourcea.To the best of my <br /> knowledge,the only waste all contained In my DIY(CESOG collection tank Is soloy from DIY and/or CESaG sources.I have not mixed this waste till with tiny other hazardous waste or waste oil <br /> from other sources.I agree to accept the additional charges for disposal of this waste If the Informallon I have provided about this wasto is Encarrimt <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 1 have determined to be economically practicable and that I have selected the <br /> practicable method of Irealment,storage,or disposal curreritty available to me which m1nimizes the present and future threai to human life and the environment. <br /> This Individual signing In rhe space set forth below on behalf of customer represents and warrants that ho/sho has the authority to bind customar,tical the forgoing descriptions of waste <br /> and materlala aro true and accurate as packaged,markotl,and labeled,am rowdy for transportallon In accordance with eppl{cable elate and federal regulations,and/fret customer shall abide <br /> by Ilio Standard Tdrms and'Coilditians on the revt:rsc side of this ServEco Order. <br /> qS,r,J,,, ers with a aasacla]ad hazardous waste manlfeet(either site specific or consolidated)are suhl!oct to an EPA Fee.These fees cover the EPA pass-through fee and administration <br /> Yost pr m. These fees vary.based on Manlfest type. Applicable fees will appear on your Wiling Invoice. <br /> r "1 / ►3t x,13e Signature <br /> _,_!,Date Di-I&TVgnature Date <br /> Print Name Print Driver Name <br />