Laserfiche WebLink
f1 -111e& <br />FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-7-ASBURY <br />INION CITY OFFICE <br />t-888-603-8844 <br />;NICO OFFICE <br />100-733-9043 <br />A01 --t <br />V <br />'S� W, <br />H . <br />W <br />5I=KVIL;t UKL)t:K <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA # CAD028277036 <br />914" <br />i <br />FORM NO. AES004-B (REV 10107) <br />SERVICE 0 DER NO. <br />---------------- =�_ <br />UNIT PH <br />HIS ER <br />CASH REG I <br />ZE!, 13PY 1::1-101A I S <br />FILE 61— <br />CHECK# <br />'D� <br />WASTE DISPOSAL INFORMATION <br />ILJMIXED OILS) 'NO PLACARDS REQUIRED* <br />RA HAZARDOUS WASTE; LIQUID (USED 0 'NO PLACARDS REQUIRED* <br />.NON.7.RC E GLYCOL SOLUTIONS) <br />NONACRA HAZARDOUS WASTE, LIQUID (ETHYLEN - <br />OTHER: <br />DESIGNATED TSDF: <br />ALTERNATE TSDF: . Uni®n City, CA 94587 1-510-487-9277 <br />SA RECYCLING: 3321 o Western Avenue,FACILITY: BSC_ <br />kTE CODE 221 <br />'21iEtODE - <br />RTIFICATION <br />GENERATOR WASTE C <br />PLEASE CHECK THE APPROPRIATE BOX <br />and is in proper condition for transportation, accord <br />This is to certify that the waste described above is property classified, d I escribed, packaged, marked and labeled, <br />and federal regulations. By signing below I also hereby certify that: heck ONE of the following three boxes] <br />(Waste oil generator/customer MUST c pm and the waste does not <br />the total halide content is LESS than i,000 P - <br />with any other hazardous waste, determine this Is true. I agree to accept the additional charges for I <br />0 #1) 1 have not mixed any of the waste described above management regulations to <br />Of the applicable California used oil manage <br />complied with the requirements about this waste is incorrect <br />if the information) have provided Hazardous waste, the total halide content is GREATER than 1,000 Ppm, and the .waste does <br />waste described above with any other naz 0 that this waste was mixed with other hazardous waste.I agree to 2' <br />0 #2), have not mixed any of the ion to Asbury Environmental Services to rebut the presumption t <br />have provided proper documental provided about this waste is incorrect <br />for the disposal of this waste it the information I have P and/or conditionally exempt small quantity generator (CESOG) source <br />0 #3) This waste is from a tank which collects waste oil from household "do-it-yourself' (DIY) an ave not mixed this waste oil with any tithe <br />SQG coilection tank is soley from 01Y andler CESQG sources. I h <br />knowledge, the only waste oil contained in my oly/ CE sposal of this waste if the information I have provided about this waste is incorrect <br />waste oil from other sources. 1 agree to accept the additional charges for di read the following text and check the associated <br />(AI{ generators/ customers MUST j to the degree I have determin <br />have a program in place to reduce the volume and toxicity of waste generate( <br />e which minimizes the present and future thr' <br />erator, I certify that I est waste management in <br />0 #4) if I am a large quantity gen method of treatment, storage, or disposal currently available to m <br />practicable and that! have selected the practicable me d faith effort to minimize my waste generation and select the b, <br />mail quantity generator, I have made a 900 <br />the environment; Or, if I am a s <br />to me that I Can afford. <br />Driver 539quture <br />Date <br />Custom& Signatuf6 <br />Print Drivers Name <br />State <br />ont I am any PCBs. I have <br />le disposal of this waste <br />lot 0ontain any PCBs- I <br />cept the additional Charges <br />s. T6 the best of my <br />hazardous waste or <br />I t6 be econonlicaliY <br />I td:human life and <br />todthat is available <br />Date <br />