Laserfiche WebLink
SERVICE ORDER <br /> DIXON OFFICE <br /> 1-800-7-ASBURY �I FORM NO,AES0048 IREV INB7) <br /> — SERVICE ORDER NO. <br /> UNION CITY OFFICE <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> x <br /> a 1-800-974-4495 <br /> P , `I <br /> E i <br /> ° TRANSPORTER EPA#CAD028277036 <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# ;CONT;ACTNAM;E70RDER7TAKENBY;HA7L1DESDATE REQUIRED DATE ENTERED NEXT SERVICE DATE <br /> PART# DESCRIPTION QTY UNITPRICE QTYP/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED 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 /> DRUMSPIU: 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 Fortify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 a1)I 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.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#211 have not mixed any of Ne 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.1 agree to accept the additional charges <br /> for Me disposal of this waste if the information I have provided about this waste is incorrect <br /> Y3)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 best of my <br /> knowledge,Me only waste oil contained in my DIV CESQG collection tank is coley from DIV and/or CESQG sources.1 have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.1 agree to accept Me 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 /> ❑sa) If I am a large quantity generator,1 certify Mat I have a program in place to reduce Me volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected Me practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> Me environment;Or,if I am a small quantity generator,l have made a good faith effort to minimize my waste generation and select the beat waste management method that is available <br /> to me Mat I can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />