Laserfiche WebLink
FOR SERVICE CALL: . SERVICE ORDER <br /> DIXON OFFICE 'ORM NO.AES004E(REV 1N7) <br /> 1-800-7-ASSURY SERVICE ORDER NO. <br /> UNION CITY OFFICE <br /> 1 -98-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON,CA 90221 <br /> R 1-310-886-3400 <br /> a i t d E. LS t y_`=. TRANSPORTER EPA#CAD028277036 ., ,l i r.;I_ j i,y(^ <br /> p <br /> E <br /> D <br /> o �`,rlia`F7dI <br /> CUSTOMER# PURCHASE ORDER# ROUTE# j TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 1. <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> YF}.XI ii [jl.I..'a <br /> l a <br /> TOTAL <br /> CAkSHREC'D: 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-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE_ <br /> OTHER: <br /> DESIGNATEDTSDF: _ ILI: uui&7la / AR fIOUPOW Ictal uidhd, i''A /541) 1'4-rfafTo0t1F"+„tA�, <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 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 /> "0 #1)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 <br /> compiled 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 /> D#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.1 agree to accept Me additional charges <br /> for Me disposal of this waste if the information I have provided about this waste is incorrect <br /> O#3)This waste is from a lank which collects waste oil from household"do-it-yourself'(DIY)andlor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESQG collection tank is soley from DIY andlor CESQG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.I agree to accept Me additional charges for disposal of this waste if the information 1 have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> #a) if I am a large quantity generator,I certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> .{ -able and that I have selected Me practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> t rironment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the beat waste management method that is available <br /> to me that I can afford. <br /> ustomer Signature Date Driver Signature Date <br /> kl--.. n-._.n-...--- I--- <br />