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: <br /> 562-231-1550WORLD OIL <br /> UP <br /> ENVIRONMENTAL SERVICESTM <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> H ANTONIN! ENTERPRISES LLC- LA T HROP 1-800-727-2879 ANTONINI ENTERPRISES LLC-ANT <br /> E �01 DAR C`r'��� WWW.WORLDOILCORP.COM PO BOX 868 <br /> D TRANSPORTER EPA#CAD028277036 <br /> T LATHfdOP,GA 9533G STOCKTOIN, CA 9521 <br /> ,?09� � �-s 95 (209) 4.66-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ANT 605 CER-36 JOHN SCHEDULED-I <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILI.of LADING/MANIFEST# <br /> 7J3'142020 7122/2020 CAL00038 5703 <br /> PART# DESCRIPTION OTY UNIT PRICE OTY P/U TOTAL <br /> C'F USED METAL CIL.AND GASOLINE FILTERS <br /> Oi-Di OIL FILTER DRUINi REPLACEMENT- 1,10 CHARGE I <br /> �rnyN 2:'a-466-.tyOG E3r;TGH <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:_. r^,n! ar nn :.I r.;lnnr '!r sn!n .,,r,:r..,, -� r•n�.r n,aiiRln r�ri r r rc •r,nr ��h <br /> DESIGNATED TSDF: 5r; [NniMiTRIA1 f]r'IV^ 5i 11TF [In 111 INGSTON rA 9:;31A FOM 7:i7.Asg f 4i 417a��;CG <br /> ALTERNAT <br /> L-i ;rtt�s `�ir¢ Aacourlt Pliattaefer: Sam Read <br /> DRUMS Pit <br /> 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 /> CJ#I)I have not mixed any of the waste described above with any other hazardous waste,the total halldu content is LESS than I,=ppm,and the waste does not cardaln any PCBs.I have <br /> compiled with the requirements of the appticabin Callfornla used oil management regulations to doiormino this Is true.I agree to accept the addltional charges for the dleposel of this waste If <br /> Iho Information I have provlded about this waste Is Incorrect <br /> 0 U1 have not mixed any of Iho waste described above with any other hazardous waste,the total halide content Is GREATER than 1,040 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documertlailan to World Oil Environmental Servtcas to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the addillonai <br /> charges for the disposal of fAlc wnslo It the Information I have provided about this waste Is tncorrect <br /> 0 03)Tills waste is from a tank which coltests waste all Imre"household'-do•it-yourself'(DIY)andlor conditlonally exempt small quanrity generator(CES00)sources.To the best of my <br /> knowicdge,[lie only waste oil contained In my DlY1 CESOG coilectl on tank Is snky from DIY andlor CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sourcev.I agree 10 accept the additional charges for disposal of this waste It 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 texlclty of waste generated to the degree I have determined to be economically practlaabte and that I have selected the <br /> practicable method of treatment,storage,or disposal currently avallabie to me which minlmlzes the present and future threat to human fife and the environment. <br /> This lnc!Mduel signing In the space set forth below on behalf of customer represonla and warrants that hWshe has the authority to kind customer,that the Torgoing descrlpSlons o}waste <br /> and in I. InI aro t 11 Me as packaged,marked,and labeled,are ready for transportatlor+In aceurdanca with applicable slate artd federal regulatlons,and that customer shall abide <br /> ewlth <br /> ems and Cond ons"the reverse side of this Service Order. <br /> ith an associated h zardous waste manifest(either site specific or consolidated)are suhl1ect to an EPA Fee.These foes cover the EPA pass-through fee and administration <br /> program.These fee vary based on Manifest type. Applicable fees will appear on your billing Invoice. <br /> ignature Date Driver Signature Date <br /> Print Driver Name <br />