COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: SERVICE 1 ORDER PAPOER a ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-0 (1117) 559-498-0240 �;'d' i,:j • SERVICE ORDE FOR ACCOUNTING CALL: '/ 562-231-1550 Ai- 11L0 WORLD OIL ENVIRONMENTAL SERVICES. l H JU 1-Y 1.04- 14287 EAST MANNING AVE,PARLIER CA 93648 P1 5,,-)0 L KY.FII f 10A(,Q 1-559-498-0240 14r1 E f.•i%}L)"rrjLY CSII t.If t." `y t? rlf: WWW.WORLDOILCORP.COM ( A TRANSPORTER EPA#CAD028277036 VfEST S'+CtZ'11,1` i lZi • CA 9'",=°1 o k30 ffildr 316.1155 I - CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES � 1 DATE REQUIRED DATE ENTERED NWSFRVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# � , . .i .. C:ALCCk=SI'11F:'�3E`� •.�I�'11{-r 1� j 't �. �I II PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL I ;HY1..L!41-- `it•+ti z1.5+:)1.L;IION `, i � 1i .1f s �tietxt!: !',il T•:)C;K DIXON-OKI 10442 FXPiRFD TOTAL ' CASHREC'D: CHECK# w:r:O,nY hn.:tur7.Si•it •.SV:iy I 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: DESIGNATEDTSDF: 41' 91i 114 GA-- _ - i ALTERNATE TSDF: - J DRUMS P/U: EMPTY DRUMS: FACILITY. BSC GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) IBy signing below 1 hereby certify that- 1 (Waste oil generator/customer MUST check ONE of the following three boxes) ,I .8r1)I have not mixed any of the waste describe above with any other harardous 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 ( the applicable California used oil Management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste tithe information I have provided about this waste is incorrect 1 E302 I have not mixed any of the waste described above with any other hazardous waste.the total halide content is GREATER than 1,000 Ppm,and the wane does not contain any PCBs_I have provided proper documentation to Wodd Oil Environmental Services to rebut the presumption that this waste was nixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect EJ431 This waste Is horna tank which collects waste oR horn household'do-it-yoursetf•IDIY)and/or conditionally exempt small quantity generator ICESOGI sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG 011ect-tank is Soley from Off andfor CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil 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 (All generators/customers MUST read the following text and check the associated box.) t,'ZNI if I am a large quantlty generator,)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 snh•cred the pracIKahle method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human Ide and the environment Or,if I am a small quantity generator,I have made a good faith effort to minimlre my waste generation and select the best waste management method that is available to me that I can afford. This Individual signing In the space set forth below on behalf of Customer represents and warrants that he/she has the authority to bind Customer that the forgoing descriptions of waste and materials are true and accurate as peck..gvd,marked and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse W,of daaborvks Order• CustomerSlgnatu Date '+ / `Date' / Driver Signature / Print Name -- Print Drivers Name