Laserfiche WebLink
RECEIVED BY SJCEHD (EF) on 5/13/2020 <br /> 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 /> FO CC L' N2797232 <br /> 56 2. <br /> CUNTING i WORLD O I L <br /> O hay e <br /> ENVIRONMENTAL SERVICES,,, <br /> s 7 CHEVRON WAY, DIXON,CA 95620 <br /> " HOLT OF CALIFORNIA -S T OCKTON - HOL{ 9 1-800-727-2879 <br /> P 1521 WEST CHARTER WAY WWW.WORLDOILCORP.COM P. O. BOX 100001 <br /> T <br /> STOCKTON, CA 95206 TRANSPORTER EPA#CAD028277036 SACRAMENTO, CA 95813 <br /> o (209) 993-5980 (209) 993-5980 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> HOL025 R OUTE 124 I HANS smartinez <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 1/28/2019 CAL000827892 O / 0315 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> h1r t_11-1 Y Lt=1'4G l.7LTl.VL JV LU I TUNS JUU 4,U.UU ZU.UU <br /> C/ <br /> MUST CFE.CK TRUCK SHOP FOR WASTE OIL AND AF,ETC PER SCOTT HOGART 209 4 70 4852 Conof far Truck Sho Is <br /> Dave BA fCH# <br /> TOTAL <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS) STATE CODE 221 <br /> x NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE 133 <br /> OTHER: <br /> X DESIGNATED TSDF: ASBURY ENVIRONMENTAL SERVICES-CERE_S_t 1920 MORGAN RD.,CERES,CA 953_58(20%541-1825,CAL000393860 <br /> ALTERNATE TSDF: <br /> Cross Streets: Account Manager;Sam Read <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> ;Wul,;, <br /> Ing below I hereby certify that! <br /> (Waste all generator/customer MIDST check ONE of the following three boxes) <br /> have not mixed any of the wagio described above with any other hazardous waste,the talul halide content Is LESS than 1,000 ppm.and the waste does not conlatn any PCBs.I have <br /> compiled with the requirements of the applicable California used all management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste If <br /> the Information I have provided about Ihls waste Is Incorrect <br /> 0 021 have not mixed any of the waste described above with any other hazardous waste,the total MIND content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to World OII 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 11 the Information I have provided about this waste Is Incorrect <br /> Q #3)This wasters from a tank which collects waste all from household"do-Il-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste all contained In my DIY!CESOG collection tank Is soley from MY and/or CESQG sources.I have not mixed this waste oil 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 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 Pilo and the environment. <br /> This Individual signing In the space set forth below en behalf of customer represents and warrants that he/she has the autharlty to bind customer,thatthe targoing doscrlptions of woste <br /> and materials are true land accurate as packaged,marked,and Whaled,are ready for transportation In accordance with appltcabto otato and federal roguiattons,and that customer shalt abide <br /> by the Standard Terms and Conditions on the rovarsa side of thle Servlco Order. <br /> Ser I" rdera with an aas .al d hazard ,,wama mattlfest(either site specific or consolldalad)are subject to an EPA Fee. These fees ver the EPA pass-through leo and administration <br /> of Ih efP,nl I progra h o feao y based on flnnlrest typo, Applicable fees will appear an your tilling Invoice. <br /> Customer SI ature Date Driver Sign tore Date <br /> _Louf V_ ___'l 1 <br /> Print Nama Print Driver Name <br />