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 /> FOR ACCOUNTING CALL: GWORLDOILN3695015 <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES. <br /> S .7000 CHEVRON WAY,DIXON,CA 95620 <br /> " STOCKTON SCAVENGERS ASSOCIATION 1-800-727-2879 WM OF SACRAMENTO NEVADA Al <br /> P 1240 NAVY[JF7 WWW.WORLDOILCORP.COM PO 80X 4745 <br /> D MONTHLY lllfC3 TRANSPORTER EPA#CAD028277036 <br /> T STOCKTON,CA 95206 PORTLAND, OR 97208 <br /> (209)460-3912 (916)294-4035 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> ST0621 10634249 ROUTE 1 440 O, kNGELICA MAGANA SCHEDULED-1 2 � <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIVEST# <br /> 8/25/2021 8/18/2021 CAD98073722. O2 t-Z/' g its .7�4— <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> PFOE IY USED OIL/MIXED OILS-DIY loo loo <br /> ONLY ;EG OIL PN&HAZ plu -USE USA605 FOR DIY TANK ANJELICA 209 460 3925 REQUESTOR ANGELICA MA TOTAL <br /> AMEDI IA4 VVM.COM/BLANKET PO 2021 10634249 HATCH# <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> XNON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> XDESIGNATED TSDF; f]IIO' 0 <br /> ALTERNATE TSDF: <br /> A7 r711 I REQI ILl0.1iGf'71h1,4 �4 Acwunh Mariaaer 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 /> Ca#I]I have not mixed any of the wash described above wlth any other haxardatiswaste,the total halide canlont Is LESS than 1,13o0 ppm,and the waste does not contain any PCBs.I have <br /> complied with the requlremonts of Ihn applicable California used oil managementregutalions to determine this Is true.I agree to accept Tire addlllonal charges for the disposal of th lswaste If <br /> iho fnformaUan I have provided about Ihis w=o Is Incorrect <br /> Q fithave 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 wasto does not contain any PCBs.I <br /> hav pravIdad prapordocumenlatlon to World OIl Environmental Seweas to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional <br /> ZqgcsforthedLposal ofthis waste It the Information I have providedabout Ihiswastei$Incorrect <br /> 3)Tits waste Is Ire"a tank whielt collects waste oil from household'da•It-yourzdl l'(01Y)agdlor can Mon ally exempt small qu and Itygcneralar(CESOO)sources.To tho bast of my <br /> knowledge,the only waste oil cantolned In my GIYI CESOG callacl[an lank is$cloy from 01Y andfar CESOG souroaa.I have not mixed Ihis waste oil with any other hazardous waste or waste oil <br /> ,tam other sources,f agree to accept till addllionai charges for disposal of this waste II Via 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 vo[uma and toxicity ofwasto generoicd to the degree I have de torm,nnd to be cc ono m[rai[y pracHcab[n and that 1 have selected the <br /> practleahle method of treatment,storage,ordtsposal currently available to me which minimizes the present and tutu re threal to human life and the env€ranment. <br /> This Individual signing in the fence set forth below on bohait of customer rap rac ants and warrants that helsh)has the aultwrlty to bind customer,that lite forgoing descriptions oflwl,etc <br /> and materials are accurate as packaged,marked,and Inhaled•are ready for tranaperlagon in accordance with appl[cabla stoic and federal regulalivns,and that cuslomar steal[abide <br /> by She Stand 'rms. d Condllions on the averse side of This Sarvlcc Order. <br /> Servlc rders watt associated h rdous waste menffast{ailhar site spocilic or consopdated)are sub ecl to en EPA Fee.These fees cover the EPA pass-through fee and administration <br /> of 1 rManifost pr ram.Tba. eu very based on Man lfasr type.Applicable fees will appear on your billing invoice. <br /> amer nota Date �SlgnatureDate <br /> Print Name Print Driver Name <br />