Laserfiche WebLink
SERVICE ORDER <br /> DIXON OFFICE FORM NO.AES004-B(REV 10/07) <br /> 1-800-7-ASBURY SERVICE ORDER NO. <br /> UNION CITY OFFICE = e <br /> 888-603-8844 — — — — — <br /> ASBURY ENVIRONMENTAL SERVICES <br /> s 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> A <br /> 1-800-9744495 <br /> p <br /> p <br /> E <br /> D TRANSPORTER EPA#CAD028277036 <br /> T 11. <br /> G <br /> CUSTOMER# PURCHASEORDER# 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 P/U TOTAL <br /> TOTAL <br /> _ASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)-NO PLACARDS REQUIRED- STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED` STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> CFR: 33210 Western Avenue, Union City, CA 94587 (510)487-9277 <br /> DRUMS PN: 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 properly classified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State <br /> and federal regulations.By signing below I also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 17 <br /> 011)1 have net mixed any of the wast.described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have <br /> complied with the requirements of the applicable 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 information I have provided about this waste is incorrect <br /> 0#2)1 have net mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges <br /> for the disposal of this waste if the information I have provided about this waste is incorrect <br /> 0#0)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)andlor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is Soley from DIY andlor CESOG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waxes it from other sources.I agree to accept in.additional charges for disposal of this waste if Me information 1 have provided about this waste Is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 13 "1 If i am a large quantity generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> achcable 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 Iib and <br /> environment;0d,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 /> .a me Mat I can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />