Laserfiche WebLink
r / SERVICE ORDER <br /> SAN DIEGO OFFICE " FORM NO.AES004-B <br /> 9-800-748-5744 SERVICE ORDER NO. <br /> NORTHERN OFFICE <br /> q. —10-7-ASBURY • = = =' <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S - 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> , ) I,f { �, .5+: LOS ANGELES OFFICE SAN DIEGO OFFICE NORTHERN OFFICiFj�,f1 11tr I^i•�r e.{.,1. <br /> p 1-800-974-4495 1-800-748-5744 1-800-7-ASBURY , <br /> E <br /> D TRANSPORTER EPA# CA0028277036 <br /> T t 1 +3t`j"Ti.?1 <br /> G <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> )1.1 f..V 4, G c:' ,I I t '":: I-t"i( �I.i. I I"I {;if k <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> �;. 141'. r„ <br /> f.3Ti rYl.l f. i,o-. 1. r.i- '1-(,.r'r. <br /> .A <br /> TOTAL <br /> CASH REC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILMIXED OILS)-NO PLACARDS REQUIRED' STATE CODE 221 - <br /> NON-RCRA 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 PN: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that five 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 /> Q #1)1 have not mixed any of the waste described above with any other hazardous west.,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.i have <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 1 have provided about this waste Is incorrect <br /> ❑112)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.)agree to accept the additional charges <br /> for the disposal of this waste if the information I have providedabout this waste is incorrect <br /> n#3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)andler conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste it contained in on,DIY/CESQG collection tank is Soley from DIY and/or CESQG sources.I have not mixed this waste oil with any the,hazardous waste or <br /> waste oil from other sources.1 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 /> ❑ ish If 1 am a large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> -able and that I have selected the praclicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> vironment;Qgif Yam a snlalewertMtp'tJ0'rlerator,1 have made a good faith effort to minimize my waste generation andselact the best waste management method that is available <br /> to me t afford: <br /> du"rSignature Date Driver Signature Date <br /> 6'` f `;, <br /> Print Name Print D�Name <br />