COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: ` SERVICE ORDER FORM NO.WOES004-B(8/18) DIXON OFFICE ASDURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER No. 1-800.727-2879 FOR ACCOUNTING CALL: Iti09;ae? 19 fwlawlm WORLD OIL, 562-231 1550 ENVIRONMENTAL'SERVICEST,., S 7300 CHEVRON WAY, DIXON,CA 95620 1-800-727-2879 ) 0' ?,�i,;1 P t.'�,I L; �IAd�i#(br .)' t: (! i a'1`r� (u`4�,11�t # F_ "L, 1,1i 11: 320 P WWW.WORLDOILCORRCOM E TRANSPORTER EPA#CAD028277036 T a I�,;1 (1I'S,'. A ��"10 i;lit ��z(wl, X 7(�s�1-14 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER.TAKEN 13Y HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATECUSTOMER EPA# BILL of LADING/MANIFEST# C4.6(3031. r I°I PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 'AF .��1I I`i"d�iz:h)3. T�t.'�`( �tL ;�; 1,�k'f'''H ' TOTAL CASH REC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NQN-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_, OTHER: ' DESIGNATED TSDF: A36UE'r.'icf=dVlRi°tNM*14lAi.1"fff, ; !£al wF ;fw Roll(X't .S,CA,C 631_3 ik0 .914,t �1..�3t1tf,3�,5e;fitf ALTERNATE TSDF: 1 b'httft.C3l;Y7t Ia�'c'If9�ir d'f :t;$tf1 Road DRUMS P/U: EMPTY DRUMS: FACILITY: DSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE ROX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE Of the following three boxes) Q /t1)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 compiled 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 the information I have.provided about this waste is incorrect Q #2 1 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 have provided proper documentation to World Oil Environmental Services to rebdt the presumption that this waste was mixed with other hazardous waste.l agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect t Q f13)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 knowledge,the only waste oil contained in my DIY/CESQG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges fir disposal of this waste if the Information I have provided about this waste is incorrect (All generators/customers MUST read the following text certify that t have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that l have selected the practicable method.of treatment,storage,,or disposal currently available to me which minimizes the present and future threat to human life and the environment, This Individual sign .;'in�In the space set forth below on behalf of customer represents and warrantst he/she has the authority to bind customer,that the forgoing descriptions of waste and materials are true and accurate as packaged;marked,and labeled,,are ready for transportation n'accordance with applicable state and federal regulations,and that customer shall abide by the Standard Terms d Conditions on the reverse side of this Service Order. Service Orders with an a 1 ted hazardous waste manifest(either site specific or consolidated)are subject to,an EPA 1`4—These fees cover the EPA pass-through fee and administration of the eManifest progra go fees vary based on Manifest type.Applic,,able fees will appear on your billing invoice. )) - Customer Signature Date Drive Si ature Date ' i-YO -Print Name Print Driver Name