Laserfiche WebLink
FOR SERVICE CALL: SERVICE ORDER FORM NO AES004-B WV 81151 <br /> DIXON OFFICE <br /> 1-800-7-ASBURv SERVICE ORDER NO. <br /> FRESNO <br /> 559-498-0240 <br /> CHICO OFFICE <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVIGES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> I'D <br /> S 1-310-888-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> P <br /> E <br /> r <br /> h <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> 1 r <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLE=NE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 23285 Eichler, Ste.E. Hayward,CA 94541 323.921-4784 <br /> DRUMS PIU: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that the waste described above is property classified.described packaged.maned and labeled,and is in proper condition for Itansponahon according Io apphcabie Stale <br /> and federal regulations.ey signing below I also hereby certify that <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> [1 air I have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than I,000 ppm,and the westa does not contain any PCBs.I have <br /> complied with the requirements of the applicable California used oil management faguislions to determine this Is true I agree to accept the additional charges for the disposal of this waste <br /> it the information I have provided about this waste is Incorrect <br /> 11 x211 have not mixed any of the wasts described above with any other nazardous waste.the total halide content h GREATER than 1,000 ppm,and the waste does not conlatn any PCBs.I <br /> have provided proper documentation to AAbury Environmental Services to rebut the presumptinn that this waste was mixed with other hazardous waste.I agree to accept the addibonal charges <br /> Ow the disposal of this waste it the information l have provided about this wants is incerrect <br /> []1131 This waste 1s from a tank which collects waste oil front household-do-it-yoursetf"{DIYI andror conditionally exempt email quantity generator(CESQG]sources To the best of my <br /> knowledge,the only waste oil contained in my OlYI CESOG collection tank Is away from MY andlwr CESQG sources.I have not mixed thin waste oil with any other hazardous waste w <br /> waste oil from other sources I agree to accept the additional charges for disposal of this-seta if The Information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> [] "1 II 1 am a large quantity generator,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 <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which mrnimizes the present and future threat to human lite and <br /> iiia en drwnmant, <br /> Or,if I am r small quanhly generator 1 have made a good ferlb effort to minimize my waste generatiwn and select the best waste management method that is available <br /> to me that I ten afford <br /> Customer Signature Date Driver Signature Date <br /> * Print Name <br /> Print Drivers Name <br />