Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: GWORLDOIL <br /> N3705530 <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES, <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> Fi <br /> I SPEEDEE OIL CHANGE 1-800-727-2879 <br /> P 245 W LOUISE AVE WWW.WORLDOILCORP.COM 245 W LOUISE AVE <br /> D TRANSPORTER EPA#CAD028277036 <br /> o MANTECA, CA 95336 MANTECA, CA 95336 <br /> (209) 825-5823 (209) 825-5823 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> SPE080 CER-86 702II istanton <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 8/25/2021 CAL000351460 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF DRAINED USED OIL&GASOLINE FILTERS(METAL) L/ $0.00 $0.00 <br /> OFDS OIL FILTER DRUM REPLACEMENT- NO CHARGE / $0.00 $0.00 <br /> BATIH# <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER:-{VC3N R^GRA'-'r-rAvs"RDOUS W ATE,S0619(F16TE rS GONTAINING OIL)STAR CODE 223 <br /> XDESIGNATED TSDF: AMERICAN%/ALLEY WAStF oil rs91 INni(.STRIA/ nRiuF si iiTF ,1nnNc sTom CA gss34, ( nom 7,49-4rgs,CAL0004430 <br /> ALTERNATE TSDF: <br /> Cross Streets- Account Manager.Sam Read <br /> DRUMS P/U: 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 /> ❑#1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if <br /> the information I have provided about this waste is incorrect <br /> ❑#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,and the waste does not contain any PCBs.I <br /> 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 <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-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESQG collection tank is soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste all <br /> 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 <br /> (All generators/customers MUST read the following text <br /> I certify that 1 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 treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This Individual signing in the space set forth below on behalf of customer represents and Warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Or ers with n a�dhs waste manifest(either site specific or consolidated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration <br /> I the eMa ifest oraased on Manifest type. Applicable fees will appear on your billing Invoice. <br /> Gdsmer I 6 n a t u r Date D r Signature Date <br /> Print a Print Driver Name <br />