Laserfiche WebLink
FOR SERVICE CALL : SERVICE ORDER FORM NO . WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES , DBA <br /> SERVICE ORDER NO. <br /> 1 -800-727-2879 <br /> N3775425 <br /> FOR ACCOUNTING CALL- OWORLDOIL <br /> 562 -231 - 1550 <br /> ENVIRONMENTAL SERVICES , <br /> H PROTOUGH AUTO REPAIR 7300 CHEVRON WAY , DIXON , CA 95620 <br /> 1 -800-727-2879 <br /> P 255 MOFFAT BLVD WWW, WORLDOILCORP .COM 255 MOFFAT BLVD <br /> ETRANSPORTER EPA # CAD028277036 <br /> MANTECA , CA 95336 MANTECA , CA 95336 <br /> o ( 209) 239-9250 (209) 2399250 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br /> SCHEOU <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # <br /> 11 /3/2021 10/27/2021 CAL00029926E 0Z 75 0 J ij C <br /> PART # DESCRIPTION OTY UNiT PRICE QTY PN TOTAL <br /> USED OIL Sr= FZVTCE CHARGE 1 95. 0 $95. 00 <br /> WO USED OIL / MIXED OILS 18 $ 0 . 00 $0 , 00 <br /> 1 � <br /> RATIH .# <br /> TOTAL <br /> CASH RECD : CHECK # <br /> WASTE DISPOSAL INFORMATION <br /> XNON-RCRA HAZARDOUS WASTE, LIQUID (USED OILJMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> ssssssss OTHER : <br /> ESIGNATED TSDF : WORLD OIL ENVIRONMENTAL SVCS-CERES, 1920 MORGAN RD , CERES, CA 95358 209 5414825, CAL000393680 <br /> ALTERNATE TSDF: <br /> Cross Streets; ccoun onager, am Read <br /> DRUMS PN : EMPTY DRUMS : FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> 701) l <br /> gning beiow 1 he,eby certltyIhati <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> have not mixed any of the waste described above with any other hazardous waste, the total haude'contsnt Is LESS than 14000 ppm and the waste does not contain any Pcss. Ihave <br /> compiled with the requirements of the applicable Catifornle used oil management regulations to determine this is true. I agree to accept theadditional charges for thodisposal of this waste It <br /> the information I have provided about this waste Is Incorrect <br /> J #2 1 have not mixed any of the waste described above with any other hazardous waste, the total halide content Is GREATER than 11000 ppm, and the wastedoes not contain any PCBs. I '.. <br /> rebut the presumption that this waste was mixed with other hazardous weals. I agree to accept the additional <br /> have provided proper documentation to World Oil Environmental Services to <br /> charges for the disposal of this waste If the information I have provided about this waste Is Incorrect <br /> i <br /> i <br /> . . <br /> L� 93) This waste is from a tank which collects waste all from household "do-it•yourseiP' (OIY) endlor conditionally exempt smell quantity generator (CESQG) sources. To the best of my <br /> knowledge, the only waste all contained in my DIV CESGG collection tank Is solay from DIY and/or CESGG sources. I have not mixed this waste oll with any other hazardous waste orwaste 011 <br /> from other sources. 1 agree to 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 t 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 /> me which minimizes the <br /> practicable method of treatment, storages or disposal currently available to present end 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 halshe has the authority to bind customer, that the target deacrrptbns of waste <br /> and materials aro True and accurate as packaged, marked, and labeled, etc ready for transportation in accordance with applicabls state and federal regulations: and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Orders <br /> Service Orders with an associated hazardous waste manifest (either site specific or consolidated) are sub�ipepot to an EPA F cover the EPA pass-through tee and administration <br /> of the sManifest program. These foes vary based on Manifest type. Applicableisss will appear an your It ling Invoice. <br /> )(Customer Sig re i Date a ature / Date <br /> Print Name Print Driver Name <br /> e — <br /> i <br />