Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (1/17) <br /> 1-800-7-ASBURY O SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> s 7300 CHEVRON WAY,DIXON CA 95620 <br /> 1 1800-7-ASSURY <br /> R <br /> P WWW.WORLDOILCORP.COM <br /> E <br /> D TRANSPORTER EPA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER PURCHASE ORDER ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINCVMANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK# <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 /> DESIGNATEDTSDF: <br /> ALTERNATE TSDF: <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC_ <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br /> By,,,um,below I hereby candy than <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Qa 1I I has,not mixed any of she waste dlesnlbed above witharty other hazardous waste,she total ha ele cement b LESS than i."VVm,and the wasadsb rot<mum any PCBs I lune rampasul with the requirements of <br /> the applicable,CaOromla used all maoagemem regu illons l.desamene the owe.I,gree to accept the additional[haryes fw the dlspoul of thls wane if the Informafbn 1 have provided abosn Ws waste ds lnconect <br /> Oar 1 haw,no mead any of the it.described above with any miser hazardous waste,the coal Nome content is G13"TER than 1,000 ppm.and the waste does not contain any Kaa,h <br /> haw provided oper doromeou tion to Would 011 Envatinmenlal Sernkes to rebut the praumptron that this waste was mixed In other hazardous we,..I agree to acrapt the addltlonal charges for the r#sposal of this <br /> waste If she information 1 how pronkkd about MIS waste a Imapeat <br /> =031 Thio waste is from a lank which colli waste erg from household'do-tit-yoursein m <br /> Igyl aVrx M) IN conhu.nelly exempt small quantity generator(CUsouaea To bast of my knowledge,the only waste ml contaned <br /> in my N"CESM cdlecdon Lanka so"from Ory andlor CESOG sources.I haw no mixed this wave it with any other hazardous waste or wait.till from other sources I.g to accept the ad[tldonal he,.for disposal <br /> of this wase if the brimmed.I Nw prwdM about this it,Is mcorrecf <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> CZ304l if I am is large quantity generator,l corny that I have a program in i to,educe the volume and sootcny,of waste generated to the degree I how determined to be e[onome ally practl[ahk and that I have <br /> selected the prxbcaWe method of neatmem.storage,w dispoal currently avaliable to one which minimizes she presem and future threat to human life and the enwosomenb A.0I am a,malt quantity,general.,I <br /> have made is quod fahh effort to minimize my wase geneabon and select the best wage management merh al that Is,vail.ble to me that Iran aford <br /> Thn Individual ggning In the spas set forth helow on beha#al Customer represents and warrants that Wihe has the authony,to bind Customer.that the foogobtg de.options of wane and matenhiho a Irueand arcuate <br /> as pacNagad,mnrked and IaMa[d. <br /> --di,to rr—nonatmn In arrnnlanre with aMil,able Base and federal hn,ti ions,and that Customw shall abide and be hound by the standard Terms and Conditions on the reverse <br /> side of this Service Order <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />