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FOR SERVICE CALL:
<br />DIXON OFFICE
<br />t -800-7-ASBURY
<br />UNION CITY OFFICE
<br />1-"q9-803-8844
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<br />SERVICE ORDER
<br />ASBURY ENVIRONMENTAL SERVICES
<br />1360 SOUTH SANTA FE, COMPTON. CA 90221
<br />1-$10-896-3400
<br />TRANSPORTER EPA # CAD028277036
<br />FORM NO AESGfi48 (PFt 1 W
<br />SERVICE ORDER NO.
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<br />CUSTOMER #
<br />PURCHASE ORDER #
<br />ROUTE #
<br />TRUCK}#
<br />CONTACT NAME
<br />ORDER AKEN BY HALIDES
<br />=IEREQUIRED
<br />DATE ENTERED
<br />NEXT SERVICE DATE
<br />CUSTOMER EPA #
<br />MANIFEST#
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<br />PART
<br />DESCRIPTION
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<br />PRICE
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<br />TOTAL
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<br />110,
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<br />TOTAL
<br />,AH REVD: CHEM9 PLEASE PAY FROM THIS
<br />SERVICE
<br />ORDER
<br />WASTE DISPOSAL INFORMATION
<br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILMIED OILS) -NO PLACARDS REQUIRED- STATE CODE 221
<br />NON-RCRA HAZARDOUS NfASTE, LIQUID (ETHYLENE GLYCOL. SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE -Z3
<br />OTHER:
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<br />DESI13NATED TSDF-
<br />ALTERNATE TSDF:}'r,.>"� it4il i4i'�I-I'ri `,i'+ P(Al• fits ti 't%,'i•c,ftt`#�#ft. s:,,:''_:%at.ttl<;>_a�y`�•3�.�i�tu��+l4iia.��t`.'+j
<br />CFR: 33210 Western Avenue, Union CUty, CA 94587 (510) 487-8277
<br />DRUMS PN: EMPTY DRUMS: FACILITY: BSC
<br />GENERATOR WASTE CERTIFICATION
<br />PLEASE CHECK THE APPROPRIATE BOX
<br />This is to certify that the waste deacdbed above Is properly classified, described, packaged, marked and labeled, and Is In proper condition for transportation, accwding to appkcable Stan
<br />and federal rpubtion& By signing below I Mao hereby certify that:
<br />(Waste oil generator/customer MUST check ONE of tete following three boxes)
<br />At1 i hays not mixed any of the waste described Above with any other hazardous waste, the total hallde content is LESS than 1,000 ppm, and the waste dote not contain, any PCS. I have
<br />omptled with tha regtdrements of the applicable California used oil management regulations to datarmins this Is true. I agree to accept the S"donsi chargas for tin disposel of We waste
<br />if the information I have provided about this waste Is Incorrect
<br />0 #211 have not mixed any of the waste described above with any other hazsr^ous waste, the Iota Writ content is GREATER than 1,000 ppm, and the waste don not contaln any PC&. I
<br />have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hatardous waste. I Agree to accept the additional chargaa
<br />for the disposal of this wants if the Information I baa provided shout this waste b incorrect
<br />p tai This waste is from a tank which collects watts, oil from household'do4t-yoursalr {DlY1 and/or conditionally exempt small quantity generator iCESOGI sources. To the test of my
<br />knowledge, the onty waste oil contained in my Diw CESOG collection tank Is softy from GIY andlor CESOC sources. I have not mixed this was(* oil with any olher, hazardous waste or
<br />waste ole from other sources. 1 aeras to accept tits additional charges for disposal of this waste If the infomatfon I have provided about this waste IS Incorrect
<br />(All generators/customers MUST read the following text and check the associated box.)
<br />M4I If I am a large qunntity generator, I certify that I have a program in peau to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically
<br />ads and that 1 have selected the practicable rnsthod of treatment, storage, or disposal currently available to me which minimites the Prevent and future threat to human Igs and
<br />rlronmant; Or, if I am a small quandly genarstor, I have math a good faith effort to minlmiza my wast• generation and select th best wnot* management method that Is available
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<br />Customer Signature Date Driver Signature Date
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