Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO.WOE S004-6(8j 18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER NO, <br /> FOR ACCOUNTING CALL. N382W84 <br /> 582-231-1550 0WORLDOIL <br /> ENVIRONMENTAL SERVICES- <br /> s SPl=EPEE OIL CHANGE 7300 CHEVRON WAY.DIXON.CA 95624 <br /> 8M-72r 28''9 <br /> fi 245 W LOUISE AVE WwW,WORLDOILCORP.COM 245 W LOUISE AVE <br /> pMAN'fECA,CA 95338 TRANSPORTER EPA p CA00282T1036 <br /> T MANTECA, CA 95336 <br /> a (209) 825.5823 (209)825-5823 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK 0 CONTACT NAME ORDER TAKEN BY HALIDES <br /> SPE080 ROUTE Z4� ADAM SCHEDULE-D-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE <br /> .DATE CUSTOMER EPA S BILL of LADINGI MANIFEST k <br /> I Z28f201,V21r.021 CAU=35146 <br /> PART# DESCRIPTION OTY UNIT PRICE 1.QTY PIU TOTAL <br /> PFO USED OIL t MIXEO OILS 5 <br /> 11ATfH s <br /> TOTAL <br /> CASH RECD: CHECK a <br /> WASTE DISPOSAL INFORMAT10N <br /> )NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NOWIRCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE _ <br /> OTHER: <br /> 7DESIGNATED TSDF: WORLD OIL ENVIRONMENTAL SVCS-C.ER€S 1920 MORGAN RD.CERES_CJS IK356?A9 54f-1B25„CJILOQ07N3W <br /> ALTERNATE TSDF: <br /> CT+DS$-5&*et5. - _ — —Account Manager Sam Raab T <br /> DRUMS PAP EMPTY DRUMS. FACILITY: 8SC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BIOX)i <br /> sy■ atg batow I"An"comhe ural: <br /> (Waste oil generatortcustomer MUST check ONE of the following three boxes) <br /> •T11 trete tent ttrlsed any 13111=6040 desC'Ide,t above wr1A an}of bar hu"ouI"a err 1?*tatal Agnar 6enlenl a 1E65 t>vn 1 GO pplot.and thin wawa doss no;con Nin any PCO• I fu ra <br /> complied aAth Ilse requtred.ene,appl Cahlr GFgtornin woad ,it mrnagarmml teguulr ng IG doda<rntrrr this Is true i agnea to 40OW Itw AddlllbnaI cnarpae Ip the drrpaaal of dere wash d <br /> Ilii rlor"NOa4n r hrve provided oboW Ihle waits 4 InUirrMl <br /> J r;1"ova nal mired wry at Ihs aaste deearraad adore weal wry other hasaraous waste,the Inter handr consist?is GREATER than 1.W0 ppm and In*waste dote not Contain any Peog I <br /> rt.ve prourdrd propel dvr;umrnialunn td Worid pit Efrvirdn"vental Ser'Aces to 4*Dvl thw presumtrtlon Ikal this waste was rii■od wllh other ha7nrdtu■waste.I Agree to acoW the eddnsorsrr <br /> [ha"s%3p the Arapoadl d this rash I!Rte k*wrlatron t hive prgvldad atwwl Ihia v.otte Ir mcdrnso <br /> J Al)Sus wo0a 14 ham a tenh which COAWIlk"ogle oil tram nouserrold-duel-youratir IDIYI art*cc confit lortallr rsenrpl amall 4uIsmny genrrstar ICESQGI ealmaas To the twat W my <br /> WrawletWo.the oNy*nota on ConyersW In my DIY[C&SQG Callettrao tank r rdMy tram DIY ,&0,CESOG sou run i Nee not"lie p{Ills waste ae Nl in any ofhar haae16ous*date or weete oli <br /> from arlaw eounies I ague to apcapt the additional charges For dsaposed of lints rraele d Ilse wtorinrttun I ho.6 prfavlew aboral Rule wee"It lncarreCl <br /> [All generators)customers MUST read the following text <br /> I earthy third I have a program rn plebe to nrduta the volume end hssrGlly as waste prnsralad to the aogree I na ra dot"foliaged In be economic attar pracll¢eble and that I Imre eale-tad Ins <br /> pi4dwable Inathad of psagmartt,glpNspll.or disposal duns rr"11raaa4N la ma whleh Ininunuat pro pr7ewnt and lulung 11~is human 0"and trw env lrprlfI Ann <br /> This Inoirsduar alln"In the Apao set With balvw on 4ehalt of Clueide"or reprurMs am drvrarm Iha?[went has the aW illedy to bind araaomir,that thin Ipgving drrcrlptions of waste <br /> said mateAeh ere trite and al curare as nookaped awrllyd,and Islaled.era ready tdr Iranepdeta!!pn an nrcordanoe wish eppilleablo parte and federal nvgLoWk ne,and that euetamer shall abiow <br /> try the Standard Tums And Crndlllonw om the reverse side vE Nle Arnrlca order. <br /> of ry s DIFIl Isaf pm ampal <br /> g mowdf f psou based un his"allloom o�C 0eMMMOW�t are su0fkt 10 an EPA Fes. cr s wear the EPA <br /> tppe, AapNBelle ylpiew on four tl:nrhQ ImroAce- I7Mr-rhr'°ugh r'n erns IldrnlNarrtlion <br /> A�- - <br /> Customer Signature Dons! r Signature <br /> Date <br /> Print Name Print Driver Name <br />