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FOR 3IiArii:EI—Az.: <br /> rcE <br /> }-$00-7-ASBUP.V !"—""` SER►J10E E]i7laE <br /> UNION CITY <br /> YOFFICE _ � fI-W4 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> s 1390 SOUTH SANTA FE,COMPTON, CA 90221 <br /> tl 1-3 t 0-$86-34(]0 <br /> P TRANSPORTER EPA#CAD028277036 <br /> Q <br /> T r <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PN TOTAL <br /> i:. <br /> .t•s, . ' is r'• r -.-, r"r V rt r- <br /> . 17 S z,; �-�,.:�.:. , �0( `o TOTAL 25 <br /> CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE 0RQER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS)-NO PLACARDS REQUIRED" STATE CODE 221 <br /> NDN-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED` STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> CFR: 33210 Westem Avenue,Union City,CA 94587(510)487-927T <br /> DRUMS PN: EMPTY DRUMS: FACILITY: 6SC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE SOX <br /> This is to certify that the waata described above Is property classified,descdba4 packaged,marked and labeled,and Is In Prapar condition for transpMstion,according to apWtcabh 5&410 <br /> and loderal regulations.By s4p*ng bekrw t else hereby certify that, <br /> ('Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Q 01)1 have not mimed any of the wasts described above with any other hazarrloue waste,the total halide content In LESS than 9,040 ppas,and the waste doss not coelain any PCBs,t have <br /> compiled with the regntrsmarlts of else applicable(;aptortua uaad ort mannumnerd mguWions to determine this Is true-I agree to accept the addrtlnnd chargea tar the dispusil of thio waste <br /> if the information I have provided about Nish want*is incorrect <br /> 0 42)1 have not mixed arty of the waste described above with any other kmardous waste,the total halide content la GREATER than 1.0010 pfm,and the watt*dose not conlein Any PGBe.I <br /> have Provided Proper documamapon to Asbeny environmental Services to rebid tita presompion that thio waste was clued with ocher hazefdoua weats.f tome to aceopf the additional chargee <br /> for the disposal of this waste If Me kifarmaeon t have provided about Ibis waste is incorrect <br /> 0 a])This waste ra from a Wlk which collects waste ad from houaahpk "dv-[t-yowraelr(D[Y)andfor cartditionady emamp area quantity aensealor JUS015)sources.To the hest of my <br /> knowledge,the anty waste oil contained In my DW CESOG coflaction tank is Way from DIY andlor LESOG sources.t hays nal mitred this waste oil with any other hazardous waste or <br /> waste oil from other sources.I aprea to accept the adcULwal charges for disposal of this waste If the information i have provided about We waste Is incorrect <br /> (All generatorslcustomers MUST read the follovlr ng text and tick the asssodated box.) <br /> ( #4) If i am a large quantity"nertlor,I catthy that I have a program in place to reduce the volume and toxicity of waste generated ae I hew dateratined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently syaNabie to ms wit' hes in&eras and future threat to hronan life end <br /> Me environment;Or.If i am a amid[quasuity gxnmator,t have made a good faith effort to min+mita my w8014,sena and a best atanmPme ad that is available <br /> to me It'd I can afford. <br /> _jitomer Signature Date ver natu D7 <br /> Print Nagle Print Drlve N e <br />