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DESCRIP ION <br />F. 0)7 SERVICE CALL Di ON OFF•ICE I-coo-7-A S8IJR Y <br />FRESAio <br />559-498-0240 <br />CHICO OFFICE <br />800-733-9043 <br />SERVICE ORDER <br />Frxikr ii i:,A04-111c1:v Itterlh <br />SERVICE ORDER NO — — - <br /> <br />IP tE <br />C E , <br />''641! H•s:.i.tn <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA # CAD028217036 <br />PURCHASE ORDER # ROUTE # TRUCK # <br />DATE ENTERED NEXT SERVICE DATE <br />CUSTOMER # <br />DATE REQUIRED <br />CONTACT NAME <br />CUSTOMER EPA <br />ORDER TAKEN BY HALIDES <br />MANIFEST <br />QTY LUNIT PRICE QTY P/U TOTAL <br />TOTAL <br />PLEASE PAY FROM THIS SERVICE ORDFR <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 />SA RECYCLING: 33210 Western Avenliri. Uttiori City. CA 94:537 1 IJ <br />UMS P/U: EMPTY DRUMS: FACILITY: <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />IC to certify that the waste described above is properly classified, <br /> <br />described, packagtrd, niatketi and ,!' yol for tian.,d,rtrinc,i accordwg to anct .-,au!e state <br />foderal regulations ay 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 inbred any of the waste desclihed above with any other hazardous waste, the total halide conit:ot ,5 LESS than I,GuO ppm, and the waste does not contain ar PCBs I 1 <br />,34 e <br />ripiled with the requirements of the applicable California used oil manayem('nt regulations to determine this Is hue. I agree to accept the additional charges for the dispos ii el this waste <br />he Information I have provided about this waste Is incorrect <br />f2) I have not mixed any of the waste described ahove with any other nazardons <br />VtaSta. the lotal halide content is GREATER than 1,000 pont. and the waste does not colta n any PCBs i <br />re provided proper documentation to Asbury Environmental Services to rebut the Pi estiniption Mat this waste <br />was mixed with other hazardous waste. I agree to accept Me zilditional charges <br />the disposal of title waste if the Information I have provided about this waste Is item rect <br />Ii) This waste is from a tank which collects waste oil From household "rio-it.youtself" MN and/or conditionally exeMpt small quarnitv genei aim ICESCh31sourues To the best of my <br />vIedge, the only waste oil contained In my DIY/ CESCIG collection tank s soloy from DIY autVor CESQG souiret I have not mixed this .4:we on with any other hazardous waste or <br />ttei pith-oat other sources l agree to accept the additional charges for disposal of this wait° if the intufmahon thaws provided about this waste is incorrect <br />(Ail generators/customers MUST read the following text and check the associated box. <br />iFl <br />) <br />afr a Iv uo quantity ganerator, I certify that I have a program In plae to reduce ,he volume and toxicity of waste genes- Ater' to the ,teiitee I have determined to be economically <br />licable And that I have selected the practicable method al treatment. storage. or chspcsal currently available to me which minimizes the ptesent and future threat to hu 'flan tile and <br />invironment; Or, If I am a small quantity generator. I hare Made a good faith effort to minimize my waste generation and select the best waste management method that 15 available <br />r Oat I call *front... .„ , .,„„ <br />°river f•iclilaturt-, Date <br />ASH REC'D: CHECK It <br />IMMS11101 1.1•1•11mmon. <br />BSC <br />t <br />natgl