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0 <br /> FOR SERVICALL: SERVICE ORDER FORM NO.AES004-8(F?. W <br /> EV ) <br /> DIXON OFF CE f,IA-- <br /> 1-800-7-ASZ URY �w 16, 1 SERVICE ORDER NO <br /> FRESNO WAK%M <br /> APR 2 4 7-n <br /> CHICO OFFICE <br /> 800-733- <br /> ; ly i <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON QA 90221 <br /> H 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> rz <br /> 0 –A <br /> CUSTOM ER# PURCHASE OR :R# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DA QML]RED DATE ENTERE D NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> --FART# DESCRIPTION QTY UNIT PRICE QTY PIU I TOTAL <br /> TOTAL <br /> CASHREC' %_ CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON- RA HAZARDOUS WAS LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED* STATE CODE 221 <br /> NON-F :RA HAZARDOUS WASn,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED- STATE CODE— <br /> OTHEI <br /> DESIG IATEDTSD F: <br /> ALTERNATETSDF, <br /> SARE1,YCLING; 33210WesWhiAvenue,Union City,CA 94587 1-510487-9277 <br /> 1 <br /> ORUMSP/U_ EMPTYD;tUMS:— FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This iota*Wify tat the waatedeacribed Above Is pro any elesamad,described,packaged,marked mW labol",and is In proporqondid.fbrtraxi.pavacdicrn.According to applicadal.State <br /> andfaderAt,og.s Ilona.Sy slofling below I also herece,canary met: <br /> i (Waste oil 1 leaerator/customer MUST check ONE of the following three boxes) <br /> = <br /> I have net fixed say of the waoto deacAlted so-ve MM any other 118MMOUS W&btt the total halide content Is LESS than 1,000 ppm,and the wade does not contain Any Kate,I have <br /> IN with it a rinrulooments of the appicabc CW4 arm-qsd Oil re..age,00rt nag.lations an dettr-r3irat this Is mas.I Agree to accept me additional tharaea for Me disposal of min waste <br /> It in*finfenn"an I have provided&Oa.1 this­..is ceneR <br /> 0 02)1 have not mixed my of the waste described at va with any other hazardous waste.Me total halide content Is GREATER than i3OW gam,and the waste does not contain any rocias,I <br /> have provided o spot doeumanlNiM to Asbury EnvirServices W rabid Me preoumptlDn that MW wasse Was mixed WM Omar nazardous vecle.I agran to secap,the additional charges <br /> For the disposal Or...Ans if meinformasm I have I ravicled!Ascot this waste is aconrect <br /> 13 Ali)Thle,weste is from stank which colects vanstc it fircato hauzah.ld'clovit-younsell'(DW)and1w conelitionally exempt small clizardity generator(CESQG)sources.To the Wat Of my <br /> knowledge,thalmlywaste oil mrttainedinmyDIYIC QGcollection mkist.leyfrom n[Y.diorCESQG sources.I have not raikeall ft&Waste Oil with any omen hazardous waste or <br /> Wears ad froon 0 her a,noat..I.gree to ancell the adition.1 oh.r,ax for diepacal a ans waste if the ifonn.tia.I have provided docot this w.Ate I.mceentat <br /> (All generators/custornem MUST read the following text and check the associated box.) <br /> �dIf[Am a liege quantity generator,I cletly,that I have a program M'place to reduce me volume and toxicity orwastar gonoraw to he degree I hove d reinacitobeeconomically <br /> cAkllasw at I have selected me prepuable method ortniatment,storage,or disposal currently available to me which minknizes the present and fu mrsattonumanate aw <br /> the.t nvinanateml;Or,III am a Small quantity qeflorato&I have efladit a 90041falth Won to MIAIMIZO My well generation and*qlactep;tostwatne ergan.Msmen smodthatisavallatow <br /> EZ.eersignature Date 6&, drs re Date <br />