COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Feb. 19, 2014 3:21 PM. HAMILTON SERVICES No, 1180 ::r\ P. 4 FOR,�;ERVICE CALL.: SERVICE ORDER DIXON OFFICE RECUVEr FORM N0.r,ES04B(REV 10, 7)1-800-7-ASBUf7Y SERVICE ORDER N0, UNiON CITY OFFICErrL__ t 1888.603 8844 F E 3 19 2 014 CHICO OFFICE 800-733.9043 ENVIRONMENTAL HEALTH D17PRRTAA SRY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA F6,COMPTON,CA 90221 . H lir�f'(IIl\7iJ!`1 ul'�.}{VIIG; t 1�ailvl{J� 17310=886-3400 TRANSPORTER EPA#CAb028277036 Y ��t':�rkltar7 C�.A�•i��+•art ; k�fn -A �X) �.'1II,o CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ::, ..;�;,:�. ;;��r�., 4(��:.' %}�,�ts I•r�lrl»cllv�r DATE REQUIRED DATE'ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# ` r' �;I;Ltlriliii�':�7i� ��t( I �"��.� •�� l , ART# DESCRIPTION QTY UNIT PRICE QTYP/U TOTAL. JIrCi 1 f$W oil. 1.Iti4IXF0;-11l,�Izll �" ) �Q OkP It"i'S�t° rJ t?L)r ll.41-.RVIC E C;�IAI - TOTA CASH RECD:. CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)'NO PLACARDS REQUIRED` STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID WTHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED' STATE CODE OTHER; DESIGNATED TSD F: l11K Ell XON CH EV11614 da V,01A(:Jj. ALTERNATE TSDF; SA RECYCLING: 33210 Western Avenue,Union Clty,CA 94587 1-510-487-9277 DRUMS-PIU: EMPTY DRUMS:_ FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE SOX 71116 to to certify shpt Ina waste described above Is property claasifiod,deatrSbed,packaged,marked and labeled,and Is In proper conditionns for lreportal(on,according(o applicable,Slate and federal regulations.By signing below 18184 hereby certify that; (Waste oil generator/customer MUST check ONE of the following three boxes)• . Dkill)I have not mixed any Of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 pprn,and the waste does not contain any Pcgs.I have complied with the requirements of the applicable California used oil management regulations to determine 11111119 true.I ag(ee to accept the additional charges for the disposal of this waste If Ino Information I have provided about this yrasle Is incorrect p H2)I have nal mixed any of the waste described ebeva With any other hazardous waste,the total halide content Is GREATER Than 1,000 ppm,and the waste does not c6ntafn any PCBs.I have provided proper documaniallon to Asbury Environmental services to rebut the preeumpu—that We waste was mixed with other hazardous weate.I agree to accept the addfllonal charges for the disposal of this waste If the Information I have provided about this waste Is Incorrect C]03)This waste Is from a tank which coalecta wasie oil from household"do,it-yoursalr-(CIY)and/or conditionally exempt small quantity ganaealor(CESOO)sources.To the beat of my knowledge,the only waste Oil contained In my DIY/CESQG Collection lank Is solar from DiY andfor CESQG sources.I have not'mlxed this waste till with any other hazardous waste or waste oil from other sources.I agree to accept the additional chargee for dlepoeai of this waele If the In(orma(lon 1 have provided about this waste la Incorracf (All generators/customers MUST read the following text and check the associated box,) ,0 J14) If!am a large quenllty,generator,i certify that I have a program In place to reduce the volume and toxfcily o(wa6fla gsneraled to the deproe 1 have el'rmined. be ecurtumlcally pl eueable end that f have eeleclort.Ihe proclleable method of tea iment,alorege,or dtspooat currently orallable to me whim miNmlzes the pl-" end f urs(haat to human life and lila envlronmen);De irra a Bina lquanllly goneraloil 1 have made a good faith effort to thlnlmlze my waste geperallOn ane seiec(the bast y,9ele mann men/method(hal as available tome IhaC'I c qi(off d, ��"�� t Customer Signa lire Date Driver SH ure date 1 Q, (L.r' Print Namts