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 /> N353'120C <br /> FOR ACCOUNTING CALLworILD OIL <br /> 562-231-1550 H <br /> ,!" <br /> N0 I� �� "" ENVIRONMENTAL SERVICES,. <br /> S 7300 CHEVRON WAY,DIXON,CA 95620 <br /> STOCK-TON SCAVENGERS ASSOCIAI ION 1-800-727-2879 WM OF SACRAMENTO NEVADA AR: <br /> P1210 NAVY DR PO BOX 4745 <br /> P W W W.WORLDOILCORP.COM <br /> E MONTHLY WO TRANSPORTER EPA#CAD028277036 <br /> STOC'KTTON, CA 95206 PORTLAND, OR 97208 <br /> o (209) E60-3912 (9113) 294-4035 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> S-1-0021 '10110807 F:OUTS 124 <br /> 400Istantan <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 3/15!2021 CAD980737225 ZU- "��Ll e cl <br /> ` ' �j IIc <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> AF ETHYLENE GLYCOL SOLUTIONS 50 <br /> ONLY RiG OIL PIU&HAZ plu -USE USA605 FOR DIY TANKANJELICA 209 460 3925 I:EQUESTOR <br /> AMEdlNr,46VVM COM BATCH ATOTAL <br /> — ll <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 -133 <br /> OTHER: <br /> DESIGNATED TSDF: ASRL)RY ENV)RONS SbPT L SERVICES-CF RES, 100 MORGAN RD CERFS,CA 95158 2091541-1875 [ALO 3 3 80 <br /> ALTERNATE TSDF: <br /> C'r ac� Shrp . . I I R Pit J R P01 IF7F 4 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 /> ❑111)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 /> compiled with the requirements of the applicable California used all management regulations to determine this Is true I agree to accept the additional charges for the disposal of this waste If <br /> the Information 1 have provided about this waste Is Incorrect <br /> ❑021 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 <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 d-yourself(DIY)and/or conditionally exempt small quantity generator(CESDG)sources To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESDG collection tank Is soley from DIY and/or CESDG sources 1 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 I 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 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 envlronmenL <br /> This Indfvldual signing in the space set lorlh below on behalf of customer represents and warrants that he/she has the authorlty to bind customer,that the forgoing closer Iptlons of waste <br /> and materials are true and accurale as packaged,marked,and labeled,are ready for transportation In accordance with applicable state and iederal regulations,end that customer shell abide <br /> by the Stsrtdard Terms and Conditions an the reverse side of this Service Order <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee These fees cover the EPA pass-through fee and administration <br /> of the cMan 1 program These lees vary based on Manffest type Applicable fees will appear on your billing Invoice <br /> �; / 3 Ay P <br /> / <br /> y Customer Signature Date Dr gna#ule Date <br /> ��► _ f it <br /> Pt Name Print Driver Name <br />