Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER <br /> FARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D 11/17) <br /> 559-498-0240 O SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES-, <br /> 5 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> H <br /> l <br /> 1-559-496-0240 <br /> P <br /> P W W W.WORLDOILCORP.COM <br /> E <br /> o TRANSPORTER EPA a CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER a PURCHASE ORDER g ROUTE a TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA a BILL of LADINGWANIFEST x <br /> PART 9 DESCRIPTION QTY UNIT PRICE I QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK q <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE.LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF.__ . <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By slgnlre2 belay i hereby cetdy that <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> [--);n$1 have not ndrvd any of the waste deu(bed above with arty other hazardous waste.the total halide content Is LESS Than I Oto ppm.and the,waste does rwt concern any P[as.I have comPLed with the mquiremenb of <br /> theapplicableCallermw used oil managemehe requlations to detentiw this is true agrtemaccept the addMnrxlcbarges fa dx dispoaldthh waste iftM iMmmation1 hast govidetl abom Ibh warren Incorrect <br /> Mn t have not mixed anY d the waste described ahem with arty othn hazardws waste.the Loral ha1We content is C>1VEA1Eg Shan I,(.p0 ppm.and the wase does nm contAn arty KBs.1 <br /> have Provided proper tlaumentatian to WMd WI Fnd,onmenal5evkes b rebut the prewmpllon Iwt this waste was mxeC with other hazardous waste l gree to attain the atldtional charge M the dsrwsel ddds <br /> wasre M Mernformadon I have pwdM about IN,waste is mutineer <br /> Mall)T sh waste Is from a tank which collmu waste oil from househdd'do it yourseK'IDIyI arM/w casdirlonally emnpnmail quantity goner(CESQG)source,to the best of my tmwvletge,tlw wdy waste od contained <br /> In my M1 CESQG,.[Ittd,n bank is wiry from Oly and/or CESQG source,I have rot mired IN,wane o4 whM any other hazardous wase a waste oil 4.other sources 1 agrre to accept the additional charge for dgwsal <br /> .1his wane If rhe rMarmabon I have provided about this were is incpmct <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> OHIII1amalarge quantity gennetor.I cedfy duan I base s program mpbce to reduc<the wlumeand to.miry ofwaste yeneraud to he IIII 1 base determinelm be economically practicable and that have <br /> selected the praNcabe rrwdotl of heatment usage.a dsposal cunentlyanedshe to me,which minimizes the peanut amt Mure threat to hunwl Tire and me enyboomant;o,MI am a small quantity g<oereta.I <br /> have made a goad lard aeon m mmlMie my waste 9enerellon sal sek(I IM best waste managamem nselAotl that b avalbde to me diet I can eNortl. <br /> Thu In,eud,a1entho In Ilsespacesetearth belowsobeheld,"Cunomerepresentskawarrants thathe/shehasthe And <br /> ttob suCramer,thethed!Is,bgdecy the Storwaste ahuiurd C.lsarem andaccurate <br /> as packaged,nurhd antl lebeletl.are ready for uangrnaatlon in xs,rdarsc<with applkabe slate and/adoral regulations.and that Customer shall abWe arM be baurM by the Standard Terms and t,ntl111ansM the Tesene <br /> fideddib ServiceO rs / <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />