COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

FOR SERVICE CALL: SERVICE ORDER FORM NO, WOE5004-B (8/18) DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA I SERVICE ORDER NO, 1 -500.727-2879 FOR ACCOUNTING CALL: ';r;. 13949028 WORLD ® ' L 562.231 -1550 ENVIRONMENTAL SERVICESr. 5 7300 CHEVRON WAY, DIXON, CA 95620 " CHANGE OIL NOW 1 -800-727.2679 CHANGE OIL NOW P720 E. HAMMER LANE, STE G2 730 E HAMMER !ANE UNIT 0-2 P W W W.WORLDOILCORP.COM TRANSPORTER EPA # CA0028277036 T STOCKTON, CA 95210 STOCKTON , CA 95210 0 (209) 951 -9912 (209) 951 -9912 CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN El HALIDES i CHAO90 R UTE 124 Q 2 ARMANDO Jcornoas t DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING! MANIFEST # e/22/2022 CAL000310187 d 21525rZ6E3-Tr- PART # DESCRIPTION QTY UNIT PRICE IQTY P/U TOTAL WOSC USED OIL SERVICE CHARGE 1 $0,00 $0.00 WO USED OIL / MIXED OILS 700 $0. 00 $0.00 q 2:� BATCh TOTAL CASH REC'D:_,.. . _ CHECK # WASTE DISPOSAL INFORMATION NON•RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE_ OTHER : X DESIGNATED TSDF: tP/OftI.D OIL ,JW;_r"tv' 144YF 'NT L,,NcSoCERFSb 192Q MORGAN RD CERES CA 9535829Df.".1-1825CAI 000393660. ALTERNATE TSDF: - , -- — r `;tr jaLa SE >~ 30CALLONEOR12APPREITERS Account ManaaEr Sam Read DRUMS PIU : EMPTY DRUMS:__ FACILITY: BSC GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) ay signing below I hereby certify that; (Waste oil generator/customer MUST check ONE of the following three boxes) d sl1) 16 a not mind any of the wasted dbad aboyewith any other h d sl , the total halide LOl tis LESS than 1,000 ppm,:and the waste Sides not coglaln any PODS. i have E pled with the requirements of the applicable California used all management regulations to dMery,liiie due is true. I agree to eceppt the additional chargd3 for the disposal of this waste if the informa don l have provided about this waste is incorrect '-.1 a21 have not mixed any of the waste duacribed above with any Other hazardous waste, the total he lido content is GREATER than 1,000 ppm, and the waste does not contain any PCBs. l have provided proper documentation to World Oil Environmental Semites to rebut 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 hootmelion I have provided about this waste Is incorrect .1 #3) This waste is from a lank which aqueous waste all from household "dO-Il-yOurself" (DIY) andtor conditionally exempt small quantity generator (CESOG) sources. To he best of my from o her the only I aortae tll contained o accept the ln my prey cEsona additionall chargessollection tank for disposal ofithis !waste It (be Information IC5SO ave provided abousources. I have t thisxed was waste Is incorrect Gell with any other hazardous waste or waste Oil (AIL generators/ customers MUST read the following text I 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 shooting in the space anti rh below on behalf of customer represents and Warrants that he/she has the auth0 ily tobad customer, Diet the (wooing doacApbans of waste and malaris are hub end not ate.Os pacRegod matkad3 and ladaled, Ne ready for bansponatinin acbord doe with applicable state and federal reoulaltens and that customer shag abide by the Slaocald Terms end COTHIMOR60n the rOvefse Side Of this SMISO Order, Servicewih fated baza d0 Ie fnan l I (authear alto speellio at consolidatetl) We stuaIm to an FPA Fea These fees cover the EPA pass-through fee antl administration onhe Beseto"vary baaved on Mantan type. Appdoebidloss will appear.on your billing invoice,Cusa DDate river 619na_tu a Date N t VJQt Print Name Print Driver Name