Laserfiche WebLink
FOR SERVICE ,CALL: SERVICE ORDER FORM NO. WOES004-B (8118) <br /> DIXON OFFICFr ASBURY ENVIRONMENTAL SERVICES, DBA I SERVICE ORDER Not <br /> x1.800-727-2879 <br /> iFOR ACCOUNTING CALL N3646900 <br /> 562-231 -1550 e WORLD OIL <br /> ENVIRONMENTAL SERVICES,~ <br /> a 7300 CHEVRON WAY, DIXON, CA 99920 <br /> I CHANGE OIL NOW -9ooa27na79 <br /> P 720 E, HAMMER LANE, STE G2 www.woRLDOILcoRP.coM 720 E HAMMER LANE UNIT G-2 <br /> e TRANSPORTER EPA # CA0028277036 <br /> o STOCKTON, CA 95210 STOCKTON, CA 95210 <br /> 0 (209) 951 -9812 (209) 9514912 <br /> CUSTOMER # PURCHASE ORDER # ROUTE # 1 TRUCK # CONTACT NAME ORDER TAKEN BY : HALIDES <br /> CHA090 CER-80 ARMANDO Jcampos <br /> DATE REQUIRED DATE ENTERED =_,NEXTSERVICEDATEkl PUSTOMERR A # j BILL of LADING/ MANIFEST # <br /> 8/28/2021 CAL000310187 i oZ\ 5Z6 Z-5" 3Jh <br /> PART # DESCRIPTION QTY MNIT PRICE QTY PIU TOTAL1p <br /> .. <br /> PF PAPOFLFILTEI PERDRGNI i ? $65;00 1 $65.00 <br /> OFDR OILF(ITER'DRV. MREPLAC MENT - NOCHARGE 1 $0400 ( $0.00 <br /> BATC #�, 1. TOTAL <br /> CASH REVD;' CHECK #' <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE 221 <br /> NON�RCRA HAZARDOUS WASTE,.UQUID (ETHYLENE GLYCOL SOLUTIONS) STATE GOOD_ , <br /> OTHER: TP1 0 p6TER& B�66R18)—State Elide <br /> DESIGNATED TSDF1 , r I my9•"*, M IMAaAZ944PA III NIEMEN= - '.. <br /> ALTERNATE TSDF: pppppp <br /> C '(Qtrawta OI FArCt RRIAttA 'aft r3Al i nh FffK2 PARM EllAbaalid Mdd"pifn:Bata Riled - - _ <br /> DRUMS PN: EMPTY DRUMS: FACILITY: BSC <br /> f GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> ay elgning below I hereby Certify than <br /> (Waste oil generatdr/customer MUST check ONE of the following three boxes) <br /> dit) Ihave natmlKad M,Y ofaNWeatb dewA4ad w7t any othe hcordouawagia the teW helldeoallant It LEsglhen i,aacppin,'antl}ho_WaneAgeann codtoinanY pcee, lhavo <br /> oampdaf Vrli <br /> the lnfamnllon l tnvaprorldadshoutlhla 4wldeiatnoom#t.h the rertulmmpmq 6104 epppaadep-0 fo d peadallmenegemtlnl va9u4donn to delemninethis le lme. l agree to eeoapttha addidell chargis for the tllap 1of llds Waste 11 <br /> ❑ 021 have not mtyed ahyaf alpgestip described ab yaWlpt asyprha fiat!)MW9 Mato$ algi0y)hgQde aanixdll 61110 a than 1ADD ppnh snothewaelo {}tlog foQntuldaoy P,dl3 rl <br /> have providagpropordaaignajjtatkp {o wendOii Envlronmanq�9orvMatotebul>n,prorumppogthat this Weataweeaignd wifhoiperhiisraaut waste, I aurae atAapllBbitldfJp!Hl <br /> aherpeeta,(,liigd(epoadaflhlB.e/�aNi(,lholnl9tgiotl nlpaVe Frpvldedabo}it}(duwYHgli llYaptreol <br /> 0 #3)Thlo wasteIs from a lank vlhl heoiloots waste allf household tl Ity u el1" (dM andlor ounldi n vy eaempt&mail goanayfranarstor (ma3) aaurtes. To the best of my <br /> knowledge, the only WMts all comatniarin my PIVI C2aoabefiedDon tank II yf m DIY andt#rMoo aoldship i have not mixed this waste all with any other retardate; Mate or waste oil <br /> Isom elhersauroee.lbgr#eto aadaptlhp eddlllanel chargosfwdisposul of this waste It the mlatmalian I hareprovldedepcbilhie wane is Inaprraal <br /> ,I <br /> (Ail generators/ customers MUST read the following text <br /> idadltythat lh'avgppletlrp5n.ln plshulo reduce the yo(pA,tluidottyo/weat9gendfato lha dogMlhave datarmined toganwnamlvaipraallaaWdand thatl have seleotad the <br /> pmallaeble mpltlgd trhatMienl, shnsp, or disposal owronilyfva hlslo mswhlah mtn I:eeihe pJtsthlentl tutors lhleatto ppmppllle pn IM1oenYildnmenl. <br /> 'OnahMlyldgpl dduuning nifa,a peptdlitldhldddpang )haaa ogdtdmer tauid Warm in;htll lidsha toot -a " ifwd(yfq blinded Ina that torg8ln dnapI III 4tifV{osta- <br /> andmata'nd p00, tlo* 4 asapagWgec4.rtgaVulafebekd,:,ro dv differedpoM1or, nawabrdancowpkapptbabloatetonndfaden� roguugops, on� Umtounodt'gralranoti7 e <br /> hy1fiRStands Talmapn canal)tontgnt64dIvptgg4daoriMoiottig, <br /> $arvlap Critp.bwitha a .. 1 . , INietdaig Vlplemmttooyegt (okl(eTNUa#qatlNpa ardo sal(dalad) areaabaalt&trd6PAFe& Thaaptetu' verlhaCpApoeothroughfapand'adminlelsa(lon. <br /> or, 0416nlro1 q see 4awdanH4rliflsitypa.<Appil .Ido toae WW appepl,anfotirb�INe nyolat. <br /> tura t]aM O}Iv r61gn tc Date <br /> rlpt Naris Print Driver Name <br />