Laserfiche WebLink
SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-A <br /> OSERVICE ORDER NO. <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES,. <br /> N 1300 SOUTH SANTA FE,COMPTON CA 90221 <br /> LOS ANGELES OFFICE SAN DIEGO OFFICE <br /> p 1-800-974-4495 1-800-748-5744 <br /> t <br /> r <br /> TRANSPORTER EPA a CAD028277036 <br /> ca <br /> CUSTOMER# PURCHASE ORDER If ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA P BILL of LADING/MANIFEST 0 <br /> PART# DESCRIPTION QTY UNIT PRICE QTYPIU TOTAL <br /> TOTAL <br /> CASH RECD: CHECK# <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 /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> 6;".N Wow,I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> pal l s have Trot mixed any of the waste deserters above with any other haeardous waste,the total naiades content Is LESS Bran 1.000 ppm,and the waste does net contain any PCBs I have complied with the regwremmts of <br /> thaaPPlaabk cithmna used ai maugemr "."#bons to determine this bre.Iagree to accept the additnuml charges for the disposal of this waste if the Inbrmhrb 1 have pmvlded Motors this waste Is incorrect <br /> O121 have not mmol any of the waste described above enthuse,ether hnzndous waste,The total halide mntint Is is E cep than 1.000 ppm.end the waste does not curtain any Kill,I <br /> have provided proper documenmen to World Oil Envinamerml Serdcea to rebut the M piton that INswuta was mind with oINn hazaMout waste.I agmae.M pnhe addlaonalrharges for de disposal of she <br /> wase If the Irsfmmabon I have movMN about MIs was"Is Irrcpnnt <br /> O131 Thh waste Is nor.sapk which collects.111.11 from household'dp a-yomsaff'(MI and/or conditionally Attempt small quantity gerremam ICESOGI%warms.To the best of my knowledge,the only waste al contained <br /> In my DIV CESOG cdlection sank is splay from M and/or CESOG"uices.I have not mixed this wane oil with any other haeestsus waste its waste oil from othn sources I agree to arcepr the additional cha,gea for disposal <br /> u1 IN,was"dtlm InldrrI I have p,owdd about this was"Is Inaonect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> pNl if l am a large quantity,eneratof,Icasilly that l have a program in plate to mducethe volumeuM tuaidly of Asia gee¢rae redio,he degree l nave dnennlned to be nurwouallyp MtltaW and that l have <br /> selected the psacWable,method of treatments.i mage,or disposal mrm,tly Inedeblo to me whkh panimues the Whent and future threat to human Ise and the envuonmare Or,III am a small quantity generator I <br /> have made a gond fadh effort to minfinam my,was",emission am sekct the best was"mansWorent method that is Indelible to me the,I tan aflwd <br /> This Individual slgmng in the spate set forth below on behalf of Custamr m,imsenb and aonahts that aNshe has the authority to And Cuammer,that the fergoeng descriptions el waste and diumnals are true and#aura" <br /> as Packaged,marked arms labeled,are it,for tt—porration an xcordanca with applecabk„ale amtfnle2l rpulanons.and that Cmtomel shall abkk and he hourrd by the Standard Terms and C Mraws on the raven" <br /> side u!this Snvke Orser. <br /> Customer Signature Date Driver Signature Date <br /> Dine Id— Print Drivers Name <br />