COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

)R SERVICE CALL: •.. SERVICE ORDER _ • - XON OFFICE FORM NO.AES004 E REV 10107) 900-7-ASBURY SERVICE ORDER NO. VIONCITY OFFICE . 86�-6Q3-8844. ASBURY ENVIRONMENTAL SERVICES t- ' 1300 SOUTH SANTA FE,COMPTON,"CA 90221 1-310-886-.3400 4 ' TRACY i)O:"eisf:_ CHRYSLER TkAWftNSPORTEREPA#CAD028277O36 3460 NAGLEE R*OAiY 3460 MAGUC»E ROAD TRACY. i'r, W1376 [RACY. CA 9 376 (209) 820- 1000 (209) 820-1800 :USTOMER#- PURCHASE:ORDER# ,ROUTE# .TRUCK#, CONTACT NAME ORDERTAKENBY HALIDES. TRAQt76 ! � � ?b 9�t STI VE: G L.akei.a ATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# 6!16/202 6/15/2010 CAL0003323565-re' `Y f ' PART# DESCRIPTION - - -.QTY UNIT PRICE. QTY..P/U TOTAL IFS I13'.tiR'ANCE; FUEL SURCHARGE 5. $17. 00 $1.7. 00 30-0 MA t";ALLON 01T METAL DRUM 1 $40.00 $43.20 BRAK . BR6K ' LATHE SHAVING'S PER DRUM i x+225.00 T,?25. 00 Cf- Sis .s't:i eetsi HAS WASTE ACCOUNTaj•"E TOTALS w ..r ASHREC'D CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE; LIQUID(USED OILIMIXED OILS)"NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED` STATE CODE_ OTHER: DESIGNATED.TSDF: ALTERNATETSDF: SA RECYCLIN 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 RUMS PN: EMPTY DRUMS: FACILITY/GBi"''l BSC GENERATOR WASTE CERTIFICATION 'PLEASE CHECK THEAPPROPRIATE-BOX - is is to certify that the waste described above is property classifieddescribed,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State. d federal regulations.By signing.below Ialso hereby certify that - - (Waste oil generator/customer MUST check ONE of the following three boxes) 91)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.I have mplied with the requirements of the applicable California used oil management regulations to determine this Is true.f agree To accept the additionalcharges for the disposal ofthis waste .he information i haveprovided about this waste is incorrect #211 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,.and the wastedoes not contain any PCBs.I. - veprovided 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 r Me disposal of this waste if the information 1.have.provided about the waste is incorrect #31 This waste is from a tank which collects waste oil from household`do-tt-youmelP(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To dos best of my owledge,the onlywasteoil contained in my DIYI CESOG collection tank is soley from DIY andfor CESQG sources.I have not mixed this waste oil with any other hazardous waste or isle oil from other sources.l agree to accept the additional:charges for disposal of in is waste if the information!.have providedabout this waste is incorrect (All generators/customers MUST read the following text and check` thle associa)ted box.) 94).If I am a large quantity.generator,I certify that T have a program in place.to reduce the volume and toxicity of waste y#aggii ttl1'e degree 1 nave+iTetermmed to be economically acticable and that I have selected the practicable method of treatment,storage,or disposal currently available to ik,li ninimtiee thepresent'a`nd future threat to human life and fenwronmenh Or,ift am a small quantity generator,I have made a good faith effort to romimzinny waale^,geK n�tbn�4land select the bq t Wasts.managemant method Mats available ms that I can afford !! _ ustomer Signature Date Driver Signature ;; Date rint.Name. - Print Drivers Name