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FOR'SERVICE CALL: SFiVICRDI�R' Jar
<br /> IlA OFFICE , ASBURY ENVIRONMENTAL• SERVICES, DBA. FORM NO. WOE5004=B` (4J17)
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<br /> CUSTOMER ' # PURCHASE ORDER # ROUTE# TRUCK # CONTACT NAME ORDERTAKEN BY HALIDES
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<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER"EPA's' " ` ' ` BILL of ADING/MANIFEST
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<br /> NOWRCRA HAZARRDOUS WASTEr�LIQUiD (USED O(L/MIXED"OILS) ` N ' l ' STATE CODE 221 All -w " ` `'
<br /> NON-RCRA �id R � 14(L RN #li �tYi�LFUTtIiII 011.= 'T ;1 t til ' STATE CODEIfal
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<br /> QTI�ER w '44
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<br /> GENERATOR`WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) all
<br /> Bysigningb'elow�lhereby certlfythan
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<br /> NaI (Waste oil. g661" or customer MUST check OI >* ofthe follot v) ng three bore' lls) :
<br /> # 'de'not" "ix an ' tthet ast"' iklbedolioveWithan otherhazardou's iaSte;tlietofalHalidecorifehYlsL 3 hanri;d oiim, andtl astadoi's`"notcontainanyPCBA IN I if 's>Ihavecompiiedwiththe rouir`emeritsof
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<br /> the applicable California usedoii management regulations to determine this Is true. l agree to accept the additional charges for the disposal ofthis waste if the Information I have provided about this waste is incorrect "' , ,
<br /> C,1#2 I have not mixed any of the waste described above with any other hazardous waste, the`totafhalide content is GREATERthan 1,000 ppm, antl the waste does not contain any PCBs. I
<br /> have provif4rded proJ�faa, 111 44
<br /> per tadonto,WorldOi) EnyJronmenjalServicestgrebutthepresumptiottthatthisWastewasmixedwithotherhazardouswastiel'agreetoaccepttheadditionalcharges (orthedisposalofthis ,
<br /> wasteifth J�formait9n (ttdveprovflec tioufthisvrasSei5, 1f rrect ! „v ,; .,
<br /> # Thli steisfrom 'ta"rllCwhichcolleLiSWatt2�iFfrolrihous old do-it- ourseif?(DIY)'.anoorctsndltio»allyexeinptsmallquantity generator (CESOG)sources.riothe best ofmykno'Wedge, the'onlywasteoil contained Y
<br /> inmy�31Y![JSQ 2b)le`ctid tankfs`solgyfjomDlYe"n'c bYGfSQ squnte'M "VenoT-mixedthifiv8"sfeoil'wittien otfierhazarGoriswasteor+vasteoilfromothersouices, lagreetoaccepttheadditionalchargesfordispo4
<br /> of this waste if the information I have provided about this waste Is Incorrect all
<br /> (All generators/ customers MUST read the following text and check the associatedt0k.
<br /> C2pR4) If i am a large quantity, generator, I certify that I have program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that 1 have
<br /> selected°the pratticablejnlethod bf traathtenti3tgrageinr`disposatcuPrentlyavallabfe to me Which minimizesthdipresent and future thfeattohumaniife and the environments Orr if l am a smaifquantity generator, l
<br /> havemadeajobdUltheff iNftominimizemywastegenerationandselectthebestwasternanagemehtmethod'thatisavailabietomethatf2anafford °
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<br /> This individual "signing in the space set forth below on behalf%of Customer represents and warrants that helshe has the authorityto bind Customer, that the forgoing descriptions of waste and materials are true and accurate
<br /> as packaged, marked and labeled, are ready for transportation in accordance with applicable state and federal regulations, and that Customer shall abide and be bound by the Standard Terms and Conditions on the reverse
<br /> side of this Service Order,
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<br /> ustomer� .gnatur�- s Date Driver Signature date °'
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