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FOR SERVICE CALL: SEnviCE ORDER FORM NO. WOES004-13(8/18).
<br /> DIXON OFFICE IASBURY ENVIRONMENTAL SERVICES, DBA
<br /> 1-600-727-2879 ► SERVICE ORDER NO.
<br /> FOR ACCOUNTING CALL: WORLD OIL
<br /> hI.2 ova a^
<br /> 562-231-1550
<br /> ENVIRONMENTAL SERVICES,,,
<br /> i 7300 CHEVRON WAY,DIXON.CA 9.5620-
<br /> 1 .1-800-727-2879
<br /> 552011-800-727-2879
<br /> ' ::`1 ::.I,I v. • "attic.'/.tr►. WWW.WORLDOILCORP.COM
<br /> j - TRANSPORTEWEPA'#CAD028277096
<br /> 1ri+'k?A7eCA, CA 951N-hr . . , r MA1rTI�i_'A 7
<br /> !`Tnl 239
<br /> CUSTOMER# PURCHASE ORDER # ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES
<br /> IMP47CER, : ., , -�, M. DWET 3!1401-1
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE.DATE CUSTOMER EPA#. BILL of LADING/MANIFEST#
<br /> PART# DESCRIPTION OTY UNIT PRICE CITY P/U TOTAL
<br /> PI* PAPER FILTERS PGR DRUM 3 Saw
<br /> §&-ryrh i, S5,GALLON arsfi bff
<br /> 13AATCH
<br /> —...�r._ TOTAL.
<br /> CASH•.REC'0: CHECK..
<br /> WASTE DISPOSAL iNFORMATION
<br /> TIOiJ-13CRA iWARb:IJS IAIASTE,LIOIlID.(U E6.'bf6L/M D.OILS)f + STATE CODE,221
<br /> NON=RCRA'HAZARDGU!9 WASTE,LIQUID(ETtIYLEN !DVSQpITIONS): SATE
<br /> OTHER.
<br /> DESIGNATEDTSDF: r
<br /> "ALTERNATE TSI7F: ><. ., .•,a ,,h, �r rr!q,ga.4olkmr,.,r,,a, moi.ra.w+:, . :`�e�,er
<br /> •.i. :... s' .. :,. . - ...y.b.,-U .C.„ I..a,'...,•.0nyr
<br /> T .-.r.,. if i
<br /> DRUMS PAJ;_ EMPTY DRUMS: FACILITY: BSC {'•r.,i
<br /> GENERATOR WASTE CERTII+I6AT10h(PLEASE CHECK THE'APPROPRIATE BOK) :
<br /> By signing below I hereby carmy thet:
<br /> (Waste oil generator/customer MUST check ONE of the following three boxes)
<br /> Q r1}t have not mixed my of the waste described above with any other hazardeua waste,the total halide eontant Is LESS than 1.000 ppm,and the waste does not contain any PC69,1 have., -
<br /> compiled with the requirements of the applicable California used oil management regulations to determine Ibis Is too.I agree to accept the additional charges for the dlapoaat of this waismit
<br /> the Information I have provided about this waste In Incorrect
<br /> 0 02 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,040 ppm,and the waste does not contaln spy PCBs.I
<br /> have provided proper documentation to Warld Oil Environmental Services to rebut the preautnption that this waste was nixed with other hazardous waste,l agree to accept the addwAl l
<br /> charges for the disposal of this waste If the information I have provided about this waste is Incorrect
<br /> t3}This wash Is from a lank which collects waste ell from household"do•ft•youraeil"(OM and/or conditionally exempt small q,isnitly generator(CESOG)sources.To the hest a1 my, _
<br /> knowledge,the only waste oil contained In my DIY/CFSQG collection tank is soley frori,DIY aridlor CESOG sources.I have not mixed this waste ell with any other hazardous Waste or braei¢oil
<br /> from other sources.I agree to accept the addlitonal charges for disposal of this waste it the Information i have provided about this waste is tncnrreci
<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 suture threat to human file and the environment.
<br /> This Individual signing in the space set lorth below on behalf of customer represents and warrants that he/she has the authority to bind customer,that the forgoing descriptions of waste
<br /> and materials are true and accurate ss packaged,marked,and labeled,are ready for transportation In accordance with applicable state and lederai regulations,and that customer Shall abide
<br /> by the Standard Terms end Condltlons on the reverse side of this Service Order.
<br /> .Service Orders wish an associated hazardous waste manifest(either site specific or corisolidated)are subject to an EFA Fee. These fees cover the EPA pass-through fee and administration
<br /> of the eManHest program. These fees vary ba //]]sed on Manliest type. Applicable fees will appear on your btlting invoice. ��/J//��\
<br /> = l
<br /> stomer Signature Date Driver Signature Date
<br /> •. v•t
<br /> �' iarirtf r'tritror N-:%mp
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