Laserfiche WebLink
POR SERVICE GALL: SERVICE ORDER FORM NO.WOES004-B(8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-BOD-727-2879 <br /> FOR ACCOUNTING CALL• NWll1154 <br /> ■�■ <br /> 562-231-1560 '� OnLQ OIL <br /> ENVIRONMENTAL SERVICES. <br /> SCHEVRON WAY,DIXON,CA 95M <br /> " HOLT OF:CALIFORNIA-STOCKTON-HOLM 1-800-727-2879 <br /> E 1521 WEST CHARTER WAY WWw.woRLDaLCORPcoM P. O. BOX 100001 <br /> D STOCKTON.CA 95206 TRANSPORTER EPA CA0028277036 <br /> T SACRAMENTO,CA 95615 <br /> O (209)993-5980 <br /> CUSTOMER 0 PURCHASE ORDER ROUTE M TRUCK 0 CONTACT NAME ORDER TAKEN BY HALIDES <br /> 11 V WLR JU I C 7 L4 r� ►71 CY C rC I CRO �7Ld7W�7L1=L!-i <br /> V <br /> 1DATE REOUIRED DATE ENTERED NEXT SERVICE DAYS CUSTOMER EPA 0 BILL of LADING/MAANREST• <br /> 1 W2w2 10 l LVAMFAUI a (iALAAAX`"Z10Vi9 <br /> C)"Iti 1-1 L— <br /> PART 0 DESCRIPTION OTY UNIT PRICE OTY P/U TOTAL <br /> WO USED OIL I MIXED OILS 816 $0.00 q/0 $0.00 <br /> MUST CH CK TRUCK SHOP FOR WASTE OIL AND AF.ETC PER SCOCTT HOGART 209 0 40M 9A1 O <br /> { 8-.5�Sn�tC or�orate�hartrastemarrliffasC]TA1� <br /> i�(tJxe s�tCiftoltatfzr� ed}�nrs Area <br /> Cbl l:�blst d. !r:��hcnQf t�bM [I`lasts gym. Fan vary*=$4-$10 based on IMW fast type. Appleable fea Ulf appw on Yw Invoice. <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: _ASBLiRYMOROraL4WALSEWCES&ERES,IBZLMORGANRO.,.IERO;SCA.8535I1(209)Stt. 25,r.AL3W393880 <br /> DRUMS•W. 57eots' EMPTY DRUMS: FACILITY: BSC t Morn C` o t <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIAO NUV 1 3 ZQ18 <br /> By slg rKnp below I hereby cantly Out: N� <br /> (Waste ail generator/customer MUST check ONE of the fallowing three]Ft] oxes) <br /> films nol mixed Aar of me wolifs aegvtbtd auove with sats other nazaams wosw the total haNdo tomanl Is USS than I,=ppm,and rho Waste da# Cvnmle any PClisi have <br /> 'ted w*m M requkemasSa oe me sppteabla Cs>atorsvta died on wrnagaafent regntaOvns to detsrmins brae 1s Jw.I gtva Ia aceape the addmdnel ehrq s raffia r.0 rws7t� <br /> tho kftrwWm 1 haus provided about this wasea Is IRearecl <br /> 0 #21 have Rol Wood any of the wauo described above vAh any other hazardous waste,the total bellde content Is GREATER than tj=ppm and the wane does Rol contain any PCea.I <br /> hero pro~proper docwhentatlon to World ON EmMonmental SeMcos to rebut O»presumptlon Olat lhk fasts was mbred%Ath other hazardous vraale.I agree to accept the sddltlomt <br /> charges ter the dispoaM of this waste If de Irtfoitmtlon I twvo provided about this wosb It Inca cc <br /> � <br /> wrests la lronr a lank which eoiaete waste oft from bo..aehold"do-it•yourseir[DIY)onWat coamilamlly axemol ssnc+l quanuty pcncrawr ICESOGI mecm Tot"t'csl of my <br /> Opal w' <br /> belga.the Opatle i u <br /> w conned In ray ON/CES00 eoneetton LWo is achy ham D1Y ender CESQQ source%.I have no <br /> t r4jttl Shia natio 61 wiha <br /> ts+any olr hatat0owl Wald or Witte ell <br /> ural other Sources I agmv 10 0 c am the addshonat Chari)es?Of dtlpv$60 ot this ws SM N the Into rautlon I have provided ahoul this rust@ Is InconpcI <br /> (All generators/customers MUST read the following text <br /> 1 eafutj Oral 1 Asea a prograwl In place b rod me the voWlm and toxkft ad wasto geMMod to Ns degree 1 hors de4rminfd to be econorakaft prankcabso and u,et I have selOctad the <br /> preclleatt a met1tod of beabrlerd,■brags,or deposal currenlly avaAsbte to me whleh mkdlalm Ora present and lut rre threat to human INa and Me onvircamratt <br /> TMs bunwIdual tip Ring In Me apace set 1orIR Osler Op to-Sall of cu rk m r rep rvaents and warrahtt 1hnI ho ahs ha%txe a abhenry to bird custom++,that the to^g oing and iption7 Of traalo <br /> and ma4slWs aro true and accurate as peek"W.+naiad,arw Iaaeted,ore reedy lot tro rcportOW,h cccerdsnen wish aWcable mase&%0 ledtral icgulaUt ns,and Iwtt c%rok>mer shag ablde <br /> try Sha Standard Tet ms and Condhlons on the ta.rlaa abs of INIt Servtca Order. <br /> Santee Orders vrtlh an assoctapd rurrxrgeva nasty snen+leat tvhrwr*Ito apoc pe or tontondatcdy ane avhleel p m EPA Fee. Thm left cover the EPA pass-through he and edRllnlstreGon <br /> vol Iho dU.' fTRrSe rws my bay W on Slantrvyftypo Appllcob:e ices wr1 eppoae on put IlHag lnvoks. <br /> A <br /> G StOM, Signature Date Driver Signature Date <br /> Print Name Print Driver Name <br />