|
JIJL- ct 1_il=; 04: 1=P FF13`1: T-1: _�4:-J P.4
<br /> MAY-6-2002 12:07P FR3Pr1: � W997115 P.1 -
<br /> FOR 8FIRVICE CALL: SERVICE ORDER FORM NO AJeson+ (REVto1IVI
<br /> DIXON OFFICE
<br /> 1-800-7-ASBURY SERVICE ORDER NO.
<br /> t1N1QfU CITY OFF10E
<br /> 188-603-W44
<br /> o-
<br /> A56URY ENVIRO%MENTAL SERVICES
<br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221
<br /> y 1-3104586-3400
<br /> P..I Z r4 ' 4',I it"=\ "''��' TRANSPORTER EPA 0 CAD028277036
<br /> iS
<br /> T 1',P A 9E 711;A It r' lli`,.1 C1; 9:i.?'66
<br /> CUSTOMER N PURCHASE aADER 4 ROUTE# TRUCK* CONCACT NAME ORDER TAKEN BY HALIDES
<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST
<br /> PART# DESCFIIPT10N QTY I UNIT PRICE ©TY PIU TOTAL
<br /> Tr-^� '}.�r=rt.,.�..,.�tc �""�,s,.. �l`4�r'Ft(��-r(... .i �i '.n i�,t � r.�3• ♦�Y
<br /> viva V Pl' Y �,�}J,y'ir,'.:; r''^ '.11`*'f �, f Y0ir?„'J A�.Srf')ngo
<br /> i!xl.. st ! �/ C'u°a I'` fj �='CR Dr '� ,i ,.•r-n 1'1'11 ,�J"-i. 'u➢
<br /> �.�., �%,
<br /> f",�!" 4 f” 4':rl�i , �'f �{>�Y `?;,'' f':i �? V:°r ��n t �a T`'1.1%S
<br /> TOTAL
<br /> :ASHRECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER
<br /> WASTE DISPOSAL INFORMATION
<br /> NON-ACRA HAZARDOUS WASTE,LIQUID(USED OIL1MtXED OILS)`NO PLACARDS RECU IRED` STATE CODE 221
<br /> NON.RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE
<br /> OTHER:
<br /> DESIGNATED TSDF:
<br /> ALTERNATE TSGR
<br /> CFR:33210 Western Avenue,Union City,CA 94587(510)487-9277
<br /> DRUMS PfU: EMPTY DRUMS: FACILITY; 8$C_
<br /> GENERATOR WASTE CERTIFICATION
<br /> PLEASE CHECK THE APPROPRIATE BOX
<br /> This is io eartgy!tut&w waatwdeocdbsd a6e►a is pfop+rjT afasetit*d,dpertbe4 prwlraq*4 mafked and lab*h4 and Is In'ropar eartdJtIm for Uan•paRitlm.aceordkm re aWTICatlls still,
<br /> artU tedw&l regnlagans.dy■lDel.q belay f&tea hereby aartYy drat:
<br /> (Waste oil generator/Customer MUST check ONE of the following three boxes)
<br /> 0 0131 have r+ t ddaad Ary at Ih■wash daacMW abode with arty other hia0daus waal0,the Wall 14110110 Comrnt IN LEST than 1,040 ppm,and the wast*data■61 contain any PC9e_1 have
<br /> cornpllsd wqh she rrtfulraments.of the apVleabte Caigand0 used Op marta0enlsd failul alas to datwr*w thto I•true,I aw—d&C—pt the addidorul dharpas for the disposal of this wrasla
<br /> n m r Inttnmteawr 1 Iraw prevteaa al,etrt aW waau la tr,ranaat
<br /> p sit t time not mixed arty as ahe v+aata dwadlled abowe wish any athar haurdoua waa6&,the row Falls&eonl.nt 4 4214FATIER than 1,000 pptr4 and the mate dims not eantain any WCBO.I
<br /> hay*provldad proper docurr,adagon 10 Aabwy Emkanmonikl ba-vicaa to rebrw the prosLaV Lon that this woolo Was trria0d Mtn ottwr 11WAFOatte aras;te,i aor*a to oacapt the rwdbi"'d eharaaa
<br /> for the dhpe*s or Ilths waaN 11 Wim Wo"nadon 1 have pravlow ahms ants wearm is irlcMT xl
<br /> g l,3)Thla waste V aan a tank Whlri celdecte was"ON tram hausonald-daat�yaureafr(p11r)anWor CandideneirT eratrgt trmaa rla.ansily genera w(CU4911a mee.To the best of my
<br /> inaMedpa,the only waeu oil cameined In my WI CESIM calfaction Uink Is&ally tram MY OntYor CESQ0 mwfcM I hate*not rrgno Into waste all with arty Other hateedou*wast+ar
<br /> rear*l,:1 tram Other&*ossa.)a0res to accept we adaujamm o argoe jar Aape"i d this waits if tete information I nava provided about this rugate Ea lnoerroat
<br /> (All generators/customers MUST read the following text and check the associated box.)
<br /> 0 04)1#1 am a lupe quantity liamraw,1"Mfy lhae}trews a proprarn in place to reduce the volume and saxlctly of walla 0"oraMd ee t hays doormided to t o eemnnatnlcagy
<br /> preedcAme and"t have"Wood the praoticebb e»1!t*d of traaunent,straps.OF otapoeaj ctrrangy ev04*bm m me ea the pt t std Future,thraan ti huwtan Ilya ut„I
<br /> dt&Onvlronmettt;t),Ir 1 am a amHi grunliry gtlnaratw,I have made a good faith draft to rnwrld=a any wand son uea a Mak m.rtrpnmt& ad that IN&vellra6rs
<br /> can offord,
<br /> to
<br /> 1�--- P- - t- - '
<br /> Cor Signature Data ar natu Da
<br /> '�
<br /> �t►J �dL- - f'L' 6�
<br /> .:,--- Print Drive N w
<br />
|