Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO.WOES004-B(8118) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA <br /> 1-800-727-2879 SERVICE ORDER 1V0. <br /> FOR ACCOUNTING CALL: WORLD OIL <br /> 562-231-155b-1550 N3378436 <br /> ENVIRONMENTAL SERVICES, <br /> s 7300 CHEVRON WAY,DIXON,CA 95620 <br /> MIDAS-TRACY 1-800-727-2879 <br /> P 2615 W GRANT LINE RD WWW.WORLDOILCORP.COM 2615 VV GRANT LINE RD <br /> F TRANSPORTER EPA#CAD028277036 <br /> T TRACY,CA 95304 TRACY, CA 95304 <br /> 0 (209) 832-7436 (209) 832-7436 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> MID655 ROUTE 1 LEAH PHILLIPS SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> 14/8/2020 9/30/2020 CAL000440892 02,(5- <br /> PART <br /> 2,25PART# DESCRIPTION QTY UNIT PRICE QTY PAJ TOTAL <br /> WOSC USED OIL SERVICE CHARGE 1 $95.00 $95.00 <br /> WO USED OIL f MIXED OILS 300 $0.00 $0.00 <br /> LEAH C LL 526-339-0039 BA'T'CH# TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> . NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: F58URY E�11lTRdNMENTAL 5i RVEC£S-CERES,�OMORGAN 1311,x,CA 95358{,�}5d1-1825,64000393680 <br /> ALTERNATE TSDF: <br /> Crass Streets Account Manatter-Sam Read <br /> DRUMS PIU: 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 /> 11)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 /> compiled with the requirements of the applicable California used 611 management regulations to determine this Is true.l agree to aeeept the addhional charges for the disposal of this waste ii <br /> the information I have provided about this waste Is Incorrect <br /> #21 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than i,000 ppm,and the waste does not contain any P Ces.I <br /> have provided proper documentation to world 011 Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the addltlonet <br /> charges for the disPoset 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 condltl4nally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste all contained in my DIY/CESQG collection tank Is soley from b1Y and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> 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 <br /> (Ail 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 1 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 minimlzes the present and future threat to human life and the environment, <br /> This individual signing In the space set forth below on behalf of customer represents and warrants that helshe has the authority to hind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shaft abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manliest[either site specific or consolidated]aresublecl to on EPA Fec. Th c foes cover tho EPA pass-through fee and adminlstratlon <br /> of the eManlfest program. These fees vary based on Manifest type. Applicable fees will appear on your bi[Ing Invoice. <br /> ustomer ' nature Date ri_Ver Signatur Hate <br /> n ' �'] b i r —C.t. <br /> Print Name Print Dri rr ame <br />