COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

FPR SERVICE CALL: SERVICE ORDER PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES004-D (1/17) 559-498-0240 1/I/O 450 SERVICE ORDER NO. FOR ACCOUNTING CALL: WODIY I 562-231-1550 •x-;.�� N2588067 AF 50 � WORLD OIL ENVIRONMENTAL SERVICES,. H TRACY CHEVROLET-Q&M INC 14287 EAST MANNING AVE,PARLIER CA 93648 p 3400 AUTO PLAZA WAY 1-559-498-0240 3400 AUTO PLAZA WAY P WWW.WORLDOILCORP.COM E D TRACY, CA 95304 TRANSPORTER EPA#CAD028277036 TRACY, CA 95304 T (209) 835-4500 (209) 835-4500 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES 0AN001 DER-86 �7 ,) p Ij JERRY avelazquez (DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# 5/30/2018 CAL000330423 171"(6 76 `70 J J L PART# DESCRIPTION QTY UNIT PRICED QTY P/U TOTAL 55-CfTM 55 GALLON Cif'METAL DRUM 1 $52.00 $52.00 MIXED MIXED FUELS PER DRUM 1 $225.00 $225.00 BATCH# Cross Streets: wo n/c TOTAL CASH REC'D: CHECK# Account Manager:Todd Aurit WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE OTHER: DESIGNATED TSDF: _ J ALTERNATETSDF: DRUMS P%U-_ EMPTY DRUMS: FACILITY: BSC '�Z1 GENERATOR WASTE CERTIFICATION(PLEASE CHECKTHE APPROPRIATE 8 \ �\ By signing below I here�ycertlfythat (Waste oil generator/customer MUST check ONE of the following three bo es) =#1)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 PCf)s. l �7m with the requirements of the applicable California used oll management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if the information I have w this waste is incorrect =1#21 havenot 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.I have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was muted with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information I haveprovided about this waste is incorrect 0#3)This waste Is from a tank which collects waste oil from household'do-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/CESQG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from othersources.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.) IM#i)tf Tam a large quantity generator.)certify that I have a program in place m reduce the volume and toxicity of waste generated to the degree i have determined to be r•_-onomlcallypracticable and that)have selected the prattriable method of treatment,storage,ordlsp"I currently available to me which minimlzes the present and future threat to human Elfe and the envimnmentt Or,if I am a small quantity generator,I have made agood Faith effort to minimize my waste generation and select the best waste management meNod that is avadable to me that 1 can afford. This individual signing In the space se[forth b �:[nmer represents and warrants that he/she has the authority to bind Customer,that t F rgaing descriptions of waste and materials are true and accurate as packaged,marked and 1abeEed,a y fpr transportation i accordance with applicable state and federal regulations,and that Customer shall abt a be bound by the Standard Terms and Conditions on the reverse Ude of this Service Order. A er ' nater ate Driver rat re Date Print Name Print Drivers Name