COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

, FOR ERUICE CALL: SERVICE ORDER FORM NO. WOES004-B (8/18) DIXo 4 OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA I SERVICE ORDER N0. 1 -80 727-2879 N3639650 i FOR CCOUNTING CALL: () WORLDOIL `,c, , to` 443 S (p 562-2 1 - 1550 <4= 2 ly ENVIRONMENTAL SERVICESru �• ?(OI ` 91 7300 CHEVRON WAY, DIXON, CA 95620 H & H AUTO TECH i -800427-2879 720 E HAMMER LN STE 1 OD P E HAMMER LN STE 10D yv� W*WORLDOILCORP.COM P TRANSPORTER EPA # CAD028277036 STOCKfON, CA 95210 8TOCKfON, CA 95210 (209) 951 -1100 T (209) 951 - 1100 CUS OMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES BRANDON Imenez i DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/ MANIFEST # CAL000447335 6/17/2021 PA # DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 0 • 0 VilO USED OIL / MIXED OILS 350 $0900_ !P0 $0. 00 I IATJ 0 TOTAL CASH REC'D: CHECK # WASTE DISPOSAL INFORMATION i0 -RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 0 -RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE Tf ER: ESIGNATED TSDF: ASBURY ENVIRONMENTAL SE VICE&CERESa 1924 MORGAN SO CERES rye 959 (2n91541 -1825 CAL000M0 LTERNATE TSDF: A=unt Manager: Sam Read DRU VS P/U : EMPTY DRUMS: FACILITY : BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) ey I ninglbelow 1 hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) p1 1 have not mixed any of the was" deseftbed above with any other hazardous cresta, the total halide content is LESS than 1 ,1100 ppm, and the vreate doge not contain any PC6se t have co sled v{idt the roquiraments of the applicable Canfomta used oil management regulations to determine this Is true. I agree to accept the additional charges for the disposal of thle vreao N the* tormition 1 have provided about this wast is Incorrect 0 tr21 have not mixed any of the waste described above with any other hazardous waste, es not contain any PCBs i the total halide coolant la GREATER than 1 ,000 ppm, and the oasts do j have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous west. i agree to accept the additional to ' as to� the disposal of this wast It the information i have provided about this wast Is Incorrect l7 ) This waste Is from a tank which cotiocts waste oil from household "doll-youmalt" (DIY) and/or conditionally exempt small quantity generator (CESOG) soureoe. To the beet of my fknav rom othilsourcesy Waste Oil ngroe to accept th iadditional cDlyj harges ar�posal of the waste on tank Is #*toy It the InformatDIY andtor ion I have pOG rovidedhave about this want i Is Incomeet ste Oil With any other hazardous wast or Waste Oil (All generators/ customers MUST read the following text Ic eave a program in place to reduce the volume and toxicity of wast generated to the degree 1 have determined to be economically practicable and that 1 love selected the Pmomthod Of troabnent, storage, or disposal currently available to me which minimizes the present and future threat to human life and the environment signing in the apace act forth below on behalf of customer represent and warrants that halshe has the authority t bind cuMomor, that the forgoing descriptions of waste is tore and accurate as packaged, marked* and abated, aro rowdy for tranapoAadon In accordance with app0cabie set and federal regulations, andel that customer shall abide d terms and Conditions on the reverse aide of this Service Order* lated hazardous waste manifest (either site specific or consolidated) are sub to an EPA Foe. These toes cover the EPA pass-through fee and ndmlMstratlon grog T11ese tees vary based on Manifest type. Applicable fees will appear on your b ittng invoice, k9 �5-- 'a Signature Date Dr ver Signature eta f 9�-1�i I tt�