Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-B (4/17) <br /> 1-800-727-2879 SERVICE ORDER NO. <br /> FOR ACCOUNTING CALL: 0 <br /> 562-231-1550 N2677887 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> H HOLT OF CALIFORNIA-STOCKTON- HOLOAo CHEVRON WAY,- CA 95620 <br /> I 1-800-7272879 <br /> -2879 <br /> P 1521 WEST CHARTER WAY P. O, BOX 100001 <br /> p WWW.WORLDOILCORP.COM <br /> E <br /> STOCKTON,CA 95206 TRANSPORTER EPA#CAD028277036 SACRAMENTO, CA 95813 <br /> D (209) 993-5980 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKEN BY HALIDES <br /> HOL025 ROUTE 12401EVE PETERS SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT S ER410E DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 9/24/2018 9/18/2018 CAL000827892 b ' <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> WOSC USED OIL SERVICE CHARGE 1 $65.00 $65.00 <br /> WO USED OIL/MIXED OILS 300 $0.00 90 $0.00 <br /> MUST CHECK TRUCK SHOP FOR WASTE OIL AND AF, ETC PER SCOTT HOGART 209470 4852 aATCH9. <br /> Effective 74 1!2018:Service orders with associated haz waste manifests(site speeffcicansalid red)are subjec to an EPA Fee. Fees rover EPA Pass-- <br /> Fees <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIVMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> X DESIGNATED T5DF: A58URY ENVIRONM ENTAL SERVICES-CERES.1920 MORGAN B_D $ES CA 95359 C204,Z54.-_025.CRLO00393680 <br /> ALTERNATETSDF: <br /> 4ccay <br /> Cs-�e^�„-: I <br /> 3R <br /> DRUMS P/U: EMPTY DRUMS: FACILITY:._ BSC l� <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE BOX) <br /> By signing below l hereby certify that: BY. ............................. <br /> (Waste oil generator/customer MUST check ONE of the following three boxe <br /> Of,;I have not mixed orty of the waste described above with any other hazardous waste,the total halide content Is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have complied with the requirements of <br /> / the applicable CallFurnia used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste Is Incorrect <br /> O#2 I have not mixed any of the waste described above with any other hazardous waste,the total hande content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs I <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this <br /> waste if the information I have provided about this waste Is Incorrect <br /> O#3)This waste Is from a tank which collects waste all from household'do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained <br /> In my DIY/CESQG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste all from other sources.I agree to accept the additional charges for disposal <br /> of this waste If the Information I have provided about this waste is Incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> K.01-12cted <br /> If i am a large quantity generator,I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have detetml be economically practicable and that I have <br /> the practicable method of treatment,storage,or disposal currently avallabie tome which minlmlies the present and future threat to human llle a e env/ rtrenx Or,If I am a small quantity generator,I <br /> have made a good falth effort to minimize my waste generation and select the best waste management method that is available to me that I can afford <br /> This individual signing In the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bindCustome• hat the f oing descriptions of waste and mttedals a true and accurate <br /> a:paryaged,rnarked a d labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customers all abl& d be bound by the Standard Ierm:and itions on the reverse <br /> side of this 5 +der, <br /> (l ,o� <br /> sumer 5i Lure flat ilgnature Date <br /> f� 01 (l <br /> �,�+nt— PrintrivamNama <br />