COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL., SERVICE ORDER FORM NO.WOES004 E3 (8118) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. 1-800-727-2879 FOR ACCOUNTING CALL: N3375205 562-231-1550 WO R L D A I L ENVIRONMENTAL SERVICES,,., H 7300 CHEVRON WAY,DIXON,CA 95620 P. ANTONINI TRUCKING-ANT005- 1-800-727-2879 P 15800 GALE AVE WWW.WORLDOILCORP.COM P.O. BOX 8468 , D TRANSPORTER EPA#CAD028277036 o Huron,CA 93234 STOCKTON, CA 55208 (209) 245-7503 (209)249-7503 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ANT005 MUST OBTAIN PO AR-97 JOSE ipacheco DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 9/24/2020 CAL004234986 _OZ-2-0 PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL PF PAPER FILTERS PER DRUM 2 $125.00 2-pIJ $250'00 OFDR OIL FILTER DRUM REPLACEMENT-NO CHARGE 2 $0.00 Dia $0.00 BATCH TOTAL CASH RECD: CHECK#. , WASTE DISPOSAL INFORMATION NON RCRAI.HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 2;w--- dNON RCRA HAZARDOli3 WASTE,LIQUtD ETHYLENE GLYCOL_SOLUTIONS STATE COD ., - - -OTHER. DESIGNATED TSDF: MR AZ 65385 ALTERNATE TSDFr unt Manager.JIm Dillon DRUMS PIU: EMPTY DRUMS: ACILITY: BS GENERATOR STE CERTIFIC TION (PL SE CHECK THE APPROPRIATE BOX) By signing below I hereby certify that: (Waste oil enerator/custom MU check ONE of the following threeboxes) LI#1)1 have not mixed any of the waste describ d above with any other ha rd a ,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I.have compiled with the requirements of the applicabl California used oil mane a latlons 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 wast,is incorrect El#2 1 have not mixed any of the waste describe above with any of r r us waste,the total halide content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs.1 have provided proper documentation to World Oil vironmentai S 1 abut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information abo t this waste is;incorrect ❑#3)This waste is from a tank which collects waste oil from ho ehoid` o-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESOG colla ion to is Soley from DIY and/or CESQG 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 ford pos of this'was{b if the information I have provided about this waste is Incorrect .(All gen tors/customers MUST read the following text 1 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 practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. 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 materialsere 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 by the Stan and Terms and Conditions on the reverse side of this Service Order. Service O ers with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPA Fee. These fees cover the EPA pass-through fee and administration of the a nifest program. These fees vary based on Manifest type. Applicable fees will appear on your billing invoice. Custom Signature Date Dr' er Signature Date Print Name Print Driver Name