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 /> N3169903 <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562-231-1550 <br /> ENVIRONMENTAL SERVICES, <br /> s 7300 CHEVRON WAY,DIXON,CA 95620 <br /> " STGvKTO"! SCAVENGERS A`SCGIA 10N 1-800-727-2879 W[Vi OF SAGRAi iENTO NEVADA it!� <br /> P 1240 NAVY DR WWW.WORLDOILCORP.COM P.O. BOX 6700 <br /> E VONT IDLY\AIC TRANSPORTER EPA#CAD028277036 <br /> T SI-OCKTOKCA 95205 PORTLAND, OR 97223 <br /> (209) 460-3012 (916) 234-40x5 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> Si OIj21 O:i0J033 i0'I I',:OU T E 12,°• BRIAN WATERS SCHEDULED-1 Vcu <br /> 'DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/M NIFEST# <br /> 2/2x17-;;21, <br /> 2/1 9Y2020 GAG980737225 U,: <br /> PART# DESCRIPTION QTY UNIT PRICE CQTY P/U TOTAL <br /> =OE-�.f USED OIL, MiIA"'D OILS - DIY g0 <br /> C.\IL`r R,G 41L r-M E HAZ.p/u JS.L'S�h `:FOS O:Y-AK!:i;f�JELICA 20C 4c"0 xc2-� {r�OUES On: <br /> ,�ti"l';C111� n\JJf,..%C�iO 3y CH _•- .-_-.._ TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIU(MIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: A59URb'�riViR 1I-1RiEN7AI_ -ERVIw -CFFr c 1920 tAORGAh'R❑--CER iS- CA iji51`2!239�5e 1-'925. CALy n33i587 <br /> ALTERNATE TSDF• <br /> Cro—, Sireeb.: PIU )trG 011-- G I Z?SIU7rC1IES70R7 AMP-D1NA4:r VMi,C0[%-` AcecurA,I' znPc.c-:Sar Rsnd <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRiAT BOX) <br /> By signing below I hereby certify that: MAR1 3 2020 <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q #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 doesitot•contnln any PCBs.I have <br /> complied with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional charges far tho disposal of this waste.I...... <br /> the Information I have provided about this waste Is Incorrect <br /> 0 #2[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 St The Information i have provided about this waste is incorrect <br /> t;3) <br /> This waste Ss from a tank which collects waste all from household Ido--it-yourself"(Ong and)or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,The only waste ail conuined In my flit!CESOG collection tank Is Batey from OIY and/or CESCG sources.1 have not mixed this waste aft with any other hazardous waste or waste oil <br /> from other sources.I agree to accept the additional charges for disposal of this waste If the Information 1 have provided about this waste Is Incorrect <br /> (ATI generators/customers MUST read the following text <br /> I certify that I have a pro grent In Plate to reduce the volume and toxicity of waste generated to the degroo 1 have determined to be economically praclteabIs and that 1 have selected the <br /> practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment. <br /> This Individual xlgning In the space net forth below on behalf or customer represents and warrants that he/she has The authority to bind euslomo,that the forgol ng 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 custo mershall abide <br /> by The Standard Terms and Conditions on The reverse side of this Service Order. <br /> Service Orders with an associated azardaus waste manifest(either stte specifle or consolidated)are subject to an EPA Fee.These fees cover the EPA pass-through fee and administration <br /> of the eM st program. The : vary based on Manliest type.Applicable fees will appear an your b}ti[ng Invoice. <br /> C sto er Signatu Date Driver Signature Date <br /> o 936111 A( <br /> y tint Name Print Driver Name <br />