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FOR SERVICE CALL: : SERVI ORDER
<br /> AXON OFFICE
<br /> 1-800,7-ASBURYFORM NO AES004-B(RFV 10'07)
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<br /> S RVICEORDER NO.
<br /> UNION CI FY OFFICE _ 0,' '',r
<br /> f-888-603-
<br /> 8,044 op- �`
<br /> AS'BURY ENVIRONMENTAL SERVICES
<br /> s 1300 SOUTH SANTA FE,-COMPTON CA
<br /> :90221
<br /> H t.H ! T•1, ( i I �K I,F T t ; r t,. (t,:{, .. 1-310-886-340"0
<br /> P i Gv 4+if ANSPORTER EPA#.&D028277036 '
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<br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN By` HALIDES
<br /> DAT
<br /> E REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# „ MANIFEST#
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<br /> SASH REc . P,AY FROM THIS SERVICE ORDER
<br /> WASTE DISPOSAL INFORMATION
<br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED QIL/MIXED OILS)`NO PLACARDS REQUIRED` STATE CODE 221,
<br /> NON-kCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)"NO PLACARDS REQUIRED- STATE CODE
<br /> OTHER.
<br /> DESIGNATED;.TSDF: Y;
<br /> ALTERNATE TSDFt
<br /> CFR; 33210 Western Avenue, Union City, CA 94587 (510)487-9277
<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 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 /> ❑.#1)1 have not mixed any of the waste 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..l have
<br /> complied with the requirements of theapplicable California usedoil management regulations to determine this Is true.I'agree,to accept the additional charges for the disposal of this waste
<br /> if the informational have;provided a6�out this waste is incorrect - - -
<br /> ❑42)I have not mixed any of the waste described above with any other hazardous waste,the tofal halide contentis 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 /> ❑ #3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the bestof my
<br /> .knowledge theonly waste oil contained In my DIY/CESQGcollection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or
<br /> waste oil from'other sources.I agree toacceptthe additional charges for disposal of this waste 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 /> J #4)"If I 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'miniriiizesthe present and future threat tohuman llife and
<br /> the environment;.Or,ifd am a small quantity generator,I have.made'a:good.faith effort to minimize my,waste generation-:andselect.t he•best-waste;management method..that,is available
<br /> to n that I can afford.
<br /> Customer Signature;4 ,. Date Driver Signature,, Date
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