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• SERVICE ORDER •
<br /> SAN DIEGO OFFICE FORM NO.AES004-6
<br /> 1-800-748-5744 1 SER CE,ORDER IN
<br /> NORTHERN OFFICE
<br /> 400-7-ASBURY
<br /> ASBURY^ENVIRON MENTAL SERVICES
<br /> 1300 SOUTH SANTA FE, COMPTON CA 90221
<br /> S :. r sit{-'.
<br /> H LOS ANGELES OFFICE SAN DIEGO OFFICE NORTHERNOFFIC
<br /> a 1-800-9744495 14100.748-5744 1-800-7-ASBURY
<br /> Is
<br /> E , i . . ,. : .I,6i TRANSPORTER EPA.#CAD028277036 <yy�t1 4t4t>sl,'9-;€
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<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK-# ' CONTACT NAME ORDER?AKENBY HALIDES.
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE°- CUSTOMER EPA# MANIFEST#FF
<br /> PART# ..DESCRIPTI N., ". QTY UNIT PRICE QTY PIU TOTAL
<br /> 1,0j -. i
<br /> f
<br /> =CASH'REC'Df i, - AECK "�- LEptE PAY FROM THTSSERVICE ORDER
<br /> } WASTE DISPOSAL INFORMATION ti,
<br /> NON-RCRA HAZARDOUS WASTE, LIQUtb(USED OILJMIXED OILS)-NO PLACARDS REQUIRED" STATE CODE.-ki
<br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)aN0 PLACARDS REQUIRED- STATE[CODE`'
<br /> OTHER:
<br /> DESIGNATEDTSDF:
<br /> ALTERNATE TSDF$' p r - l J '; tf'.. ' n-Iyrre ,t,,/A )4lrIjit..)37f.r747 A +zt114j2,154i
<br /> SFR: 33210 Western Avenue, Union City, CA 94587(510)487-9277 -
<br /> DRUMS PN: EMPTY DRUMS: FACILITY: : - BSC
<br /> GENERATOR WASTE CERTIFICATION
<br /> PLEASE CHECK THS APPROPRIATE BOX
<br /> Thi¢Is to certify that the waste described above is propady chssified,.d�acribed,packaged,marked and labeled,and is in proper condition for transportation,according,to applicable State
<br /> and a[regulations By signing below I also hereby cert fg,[ha4Z'
<br /> 1 Ya
<br /> Kwbste,oit geherator/customer MUST check ONE of the following three taxes)
<br /> 0#111 have Rot mixed any Othe•Wa4h described above with any other hafardous waste,the total halide content is LESS then 1,000 ppm,and the waste does not contain any PCBs.1 have
<br /> complied with the requirements of theapplicable California used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal of this waste
<br /> If the i k}9rtnabon Ihave provided about this waste is incorrect
<br /> `Iic, _
<br /> 0#2)1 have not mixed any o wast.described above with any other hazardous waste,the`tutal halide content is GREATER than 1,000 ppm,and the waste does notfcongln any PCBs.I
<br /> have provided proper docu menta o to Asbury Environmental Services to .but the presumption that this waste was mixed with other h azardous waste.l agree to accept the addition al charges
<br /> for the disposal of thisvasfe ff1fre information I have provided about this waste is incorrect
<br /> d' (DIY) Y P quantity l ) my
<br /> ❑#3)This waste is from a tank which collects waste oil from housellditl'do-it-yourself' Oly ndlor,conditional) exempt small anti) generator CESQG sources.To the best of m
<br /> knowledge,the only waste oil contained in my DIY/CESQG colleytton tank is solay from OIY and/o`-CBSQG sources.I have not mixed this waste oil with any other hazardous waste or
<br /> waste oil from other sources.I agree to accept the adtl,bonal ch es for disposal of this waste If the information I have provided about this waste is incorrect
<br /> ,(All generators/cult niers MUST read the following text and check the associated box.)
<br /> n#4) If I...large quantity generator,1 certify that I have iprogram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to beeconomically
<br /> cticable and that I have selected me practicable method of treatment,slorags,or disposal currently available to me which minimizes the present and future threat to human life and
<br /> 'environment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available
<br /> m m,a that I can afford.,,,' -
<br /> Customer Signature Date Driver Signature Date
<br /> Print Name Print Drivers Name
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