Laserfiche WebLink
FOR.SERVICE CAL':. SERVICE ORDER FORM NO,WOES004-B (8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 x`�. N3373454 <br /> ,PWC1 <br /> ORLD ®IL <br /> ENVIRONMENTAL SERVICES,. <br /> S 300 CHEVRON WAY,DIXON,CA 95620 <br /> H ANTONINI ENTERPRISES LLC- LATHRO1 1-800-727-2879 ANTONiNI ENTERPRISES LLC-ANTO <br /> P 701 D'ARCY PKWY WWW.WORLDOILCORP.COM PO BOX 8468 <br /> LATHROP,CA 95330 TRANSPORTER EPA#CAD028277036 STOCKTON, CA 95215 <br /> o (209) 993-8695 (208) 466-4900 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 10/212020 9/23/2020 CAL000385703 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> OF USED METAL OiL AND GASOLINE FILTERS 1 <br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 1 <br /> JOHN 2 66-4900 BATCH# <br /> TOTAL <br /> CASH RECD: CHECK# <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: NON-RCRA HAZARDOUS WASTE S€?LIiffJLTERS CONNTAINING C7fL)STATE COnp 223 <br /> DESIGNATED TSDF: AMERiCAN VALLEY WASTE OIL,521 INDUSTRIAL DRIVE,SUITE M,LIVINGSTON,CA 95334, (800)7324645,CAL(3004430 <br /> ALTERNATE TSDF: <br /> Cross ets: Account Manager: Sam Read <br /> DRUMS P/U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below i hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q <br /> 41)1 have not mixed any 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 <br /> 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 If <br /> the information 1 have provided about this waste is incorrect <br /> Q #21 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 waste does not contain any PCBs.1 <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 <br /> charges for the disposal of this waste if the information 1 have provided about this waste is Incorrect - <br /> Q #3)This waste Is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is Soley from DIY and/or CESOG sources.i have not mixed this waste oll with any other hazardous waste or waste oil <br /> from other sources.1 agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text <br /> ICL <br /> certi that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically practicable and that I have selected the <br /> pract cable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This ndividual 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 <br /> and aterials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide <br /> by t Standard Terms and Conditions on the reverse side of this Service Order. <br /> Se Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. a fees cover the EPA pass-through fee and administration <br /> h St.. <br /> program. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. <br /> e lgnature Dae Driv ignatureD to <br /> Pri me I Print Driver Name <br />