Laserfiche WebLink
SERVICE CALL:,ti $E IC.E ORDER PORIVI N0.AES004-8(REV 10107) <br /> ,XON OFFICE SERVICE ORDER NO. <br /> I-800-7-ASBDRY <br /> UNION CITY'�OFFICE B <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE, COMPTON, CA 90221 <br /> s 1-310-885-3400 <br /> H i` :rl1.-Y tIti"tat%,tri.:is <br /> I TRANSPORTER EPA#CAQ02827703 <br /> CUSTOMER#'• PURCHASE ORDER# ROUTE F TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> i <br /> i��_ <br /> DATIE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER I=PA#t MANIFEST# <br /> PARI# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> r ggI _Vi ..y.. <br /> t � �t frl•I 1t.tvf1 , p. <br /> TOTAL <br /> CASWKEC13: -- 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-€MCRA 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 /> (DRUMS PIU: 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 certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> y of the waste described above with any other hazardous waste,the total halide content is LESS than l,000 ppm,and the waste does not contain any PCBs.I have <br /> 7 r.-1j I have not mixed an <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 /> 7#2)1 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 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.I agree to accept the additional charges <br /> for the disposal of this waste if the information I have provided shout this waste is incorrect <br /> E,#3)Yhis waste is from a tank which coilects waste oil from household"do-it-yourself'(DIY)andlor conditionally exempt small quantity generator 1C ESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my olYl GESDG collection tank is Soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste of <br /> waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0 94) tf I am a large quantity generator,l certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree f have determined to be economically <br /> practicable and that I have selected the.practicabie method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> the environ n"Or,if I am a small`i�uantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available <br /> M me hall an afford. <br /> t 71ustorner signature <br /> Date Driver Signature Date <br /> Print Drivers Name <br /> Print N:;mp <br />