Laserfiche WebLink
FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-727-2879 <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES, DBA <br />FORM NO. WOES004-B (8/18) <br /> <br />SERVICE ORDER NO. <br /> <br />FOR ACCOUNTING CALL: <br />562-231-1550 <br />CENTRAL VAL 'ASIE <br />P E TURNER RU <br />T L001, CA 9240 <br />te WORLD OIL <br />ENVIRONMENTAL SERVICES <br />7300 CHEVRON WAY, DIXON CA 95620 <br />1-800-727-2879 <br />WWW.WORLDOILCORP.COM <br />TRANSPORTER EPA * CAD028277036 <br />A/M OF $.40?A ENTO NEVADA <br />PO BOX 4745 <br />PORTLAND. OR 97206 <br />(9161 294-4035 <br /> <br />CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br />DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # <br />PART # _. DESCRIPTION On' UNIT PRICE QTY P/U TOTAL <br />IkK V, <br />IR A <br />. Ai :._ . <br />TRUC< WASHOLI r <br />NA SPOR1AT1ON <br />TOTAL <br />CASH REC'D: CHECK # <br />_ <br />_ <br />___ <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_._ <br />OTHER: <br />— DESIGNATED TSDF: <br />— ALTERNATE TSDF: <br />— — <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 />0 #1) I have not mixed any of the waste described above with arty other hazardous waste, the total halide content is LESS than 1,000 ppm, and the waste does not contain any PCBs. I have <br />complied with the requirements of the applicable California used oll management regulations to determine thle is true. I agree to accept the additional charges for the disposal of this waste if <br />the Information I have provided about this waste is incorrect <br />0 #21 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 011 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 wattle if the information I have provided about this waste Is Incorrect <br />D 53) This waste Is from a tank which collects waste oil from household 'do-it-yourself" (OW) and/or conditionally exempt small quantity generator (CESOG) sources. To the best of my <br />knowledge, the only waste oil contained in my DIY/ CESOG collection tank is soley from DIY and/or CESOG sources. I have not mixed this waste oil with any other hazardous waste or W8826 011 <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 environment. <br />This individual signing In the space set forth below on behalf of customer represents and warrants that he/she has the authority to bind customer, that the forgoing 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 customer shall abide <br />by the Standard Terms and Conditions on the reverse side of this Service Order. <br />Service Orders with an aseocfoled hazardous waste manliest (either site specific or consolidated) are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration <br />of the eManifest program. These fees vary based on Manifett type. Applicable fees will appear on your billing invoice. <br /> <br />Customer Signature <br /> <br />Date Driver Signature Date <br /> <br />Print Name <br />Print ilrivdar NAITAI6