COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B(8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: N2957976 562-231-1550 WORLD OIL ENVIRONMENTAL SERVICES. s 7300 CHEVRON WAY,DIXON,CA 95620 H TEC OF CALIFORNIA - LOUISE AVE 1-600-727-2879 P 2050 E LOUISE AVE 2050 E LOUISE AVE P WWW.WORLDOILCORP.COM E TRANSPORTER EPA#CAD028277036 T LATHROP,CA 95330 LATHROP, CA 95330 0 (209) 858-4110 (209) 858-4110 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY 60HALIDES TEC5 CER-86 BARRY SCHEDULED-1 DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 7/25/2019 7/1712019 CAL000415460 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL OF USED METAL OIL AND GASOLINE FILTERS 2 $55.00 $110.00 OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 2 $0.00 $0.00 EATCH TOTAL CASH-RECD: CHECK# -- WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) - STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER: NON-RCRA HAZARDOUS WASTE,SOLID(FILTERS CONTAINING OIL)STATE CODE 223 DESIGNATED TSDF: - ALTERN ETSOF. - ross DRUMS P/U: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) Q !1)1 have mol mtred.,of the waste described above wIM any other healed...weeks,the total halide cement 1.LESS than 1,000 ppm,and the waste does not contain any PCBs.I have compiled with Me requirements of the applicable(alitame used oil management regulations to deterrNre Mls Is Use.)agree to accept the additional charges for the disposal of this waste If Me Informetlon 1 have provided about this waste Is Incorrect Q 121 have net mixed any of the waste described above with any other hazardous waste,Me tool halide content Is GBEATEB then 1,000 ppm,and the wase does not cousin any PCBs.1 have provided proper documentation to World at Environments[Servletas to robot the presumption that this waste was mixed wIM.MPI hazardous waste.I agree to accept Me addbl.nal chs rge.for the disposal of Nis waste It the Information I have provided about this wsele la Incorrect Q a3)This..to is from.tank which Colied.weateui from household-do-il-y.urselr (OM and/or conditionally exempt small quarely generaer(CESOG)soufces.To the best of my knowledge,the only waste oil c.usined in my DIY/CESOG cotleNon lank Is Soley head DIY hader CESOG souncss.I have not mixed this waste oil with any other heanrdove waste or wase oil from other s.urcesJ agree to accept the additional charges for disposal of the waste if the Information I have provided about this..to Is Incowea (All generators/customers MUST read the following text I cenlfy that I have a program in place to reduce the volume and toxicity of wase generated to the degree I have determined to be...nomlcally prac9wble antl that I have selected the pusedcable method of Irealmau,storage,of disposal currently available to me v.MU)minimixes the present and future threat to human life and the envlronmeaL TRIS IMtveual signing In the space set fore below on behalf of customer represents and warrants that helshe has Me authority to bind customer,brat the forgoing das�iptlens of waste antl matetlels era true end eccuate as packaged,marked,and labeled,are ready for tramper auon In accordance wim applicabla.few and tedeal regulatlons,and Met customs,ehefl abide by the Standard Tenn.and Conditions on the reverse title of this Service Order. Service Ordoa with.,aasoclated huzardous waste manifest(either site specific or consolidated)ere suoleut to an FPA Fee, as cover me FPA pass-through lee and a insm ballon .r the evanlfes,program. These fees vary baud on Manifest type. Applicable fees will appear on your billing 1,volca. Costo //Date river Signature Date .r..,,. �� Print Driver Name