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FOR SERVICE caLL SERV ICEORDERV
<br /> DIXON OFF tCE FORM NO.AESW48(REV 10107)
<br /> 1.800-7-AS URY
<br /> UNION CITY OFFICE � APR 2 4 20` SERVICE ORDER NO.
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<br /> 1-868-60.3-8944 _ _ `1` „'1 �I MENt�1 I•,;"a,:r;,.:,;.
<br /> CHICOOF CE � l MRON
<br /> 800-733-90,'3
<br /> ASBURY ENVIRONMENTAL SERVICES
<br /> s 1300 SOUTH SANTA FE,COMPTON,CA 90221
<br /> H 1-310-886.3400
<br /> a TRANSPORTER EPA#CAD028277036
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<br /> USTOMS # PURCHASE ORD R# ROUTEW_ TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES
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<br /> TE REQ RED r!-C�r''r
<br /> DATEENTERE NEXT SERVICE DATE CUSTOMER EPA# MANIFEST#
<br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL
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<br /> TOTAL
<br /> CASH RECD CHECK# PLEASE PAY FROM THIS SERVICE ORDER
<br /> WASTE DISPOSAL INFORMATION
<br /> NON-R RA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED" STATE CODE 221 r =I ..
<br /> NON-R RA'HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)`NO PLACARDS REQUIRED` STATE CODE Cyt 'r
<br /> OTHER:
<br /> DESIGNATED TSDF: .end
<br /> ALTERNATE TSDF: "•"�
<br /> SA REC CLING: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 -
<br /> DRUMSPdJ: EMPTYD MS: FACIUTY: BSC
<br /> GENERATOR WASTE CERTIFICATION
<br /> PLEASE CHECK THE APPROPRIATE BOX
<br /> This Is to certify th Itthe wane cls bed above is pr,pe Ayreseilsd,described,WKaped,markedand labeled,and is In proper condition for transportation,accordin to
<br /> and federal rgryla ons.By signing below I also hereby c artily Mal: g aPPNceb10 state
<br /> (Waste oil g nerator/cvstorner MUST check ONE of the following three boxes)
<br /> qXjl I have not m sad any of the waste described ahoy wait any other hazard o.waste.Me total halide content is LESS than LOW ppm,and the waste does not contain any PCBs.I neve
<br /> wmpllea'ivith tine aquimments of the applicabl.Califo in used oil management regulations to determine this IS true.l agree to nOWthe additional Charges for the disposal of this waste
<br /> if the irdara,aton I have pmvielee about this waste is in annct'
<br /> G#211 have not m ed any orthe waste described Sbov with any other haz9rtlous waste,the fatal NAW content is GREATER Man 1,000 ppm,add the waste One not contain any PCB,,1
<br /> have provided prOF ar aocumerdaton to Asbury Erwhon,lemial Services to rebut the masumptim,that this lysate was mitred with other hasardwe washl agree to accept the addltonal charges
<br /> for the deposal of his waste 11 MeiM-Imation l have Weed about tlds Waste ie,akar,,"
<br /> 0 M•1)This West&is From a tank which collects want,dl 1 mm household"do4t-youmoar(bly)aadrof conditmally Remat small quantity Warsaw(CalAW)source..To the tpe{of
<br /> knowledge,the an waste all enn(eined in my DWI CES G cailactim lank is Raley from Gly and/or CEsgG sources,I have net-lead tale Waste oil with any otter hazardous wastemy,or
<br /> waste ml from othe r sources.l agree to accept the addlt aral charges for disposal of MIS Met-t-e 11formall n l have provided about this want*is ma..ct
<br /> ,,nn�� (All generators/c stomers MUST read the following text and check the associated box.)
<br /> spa)If l am a hrg quantity On star,I Misty flat I h e a program in pace to reduce the volumgenerated e adtl toxicity of Waste to the degree I have isteam nen to be aconmdca ly
<br /> jar` acticable and MR t I have selected the practicable mete rd M brag li storage,or disposal eur,vogy avaiW ble to me Which minimizes the present and sabre threat ao human life and
<br /> sheMii acan allnt: ,if amasmallgdemity generator
<br /> e
<br /> to ,I ave made a goodfilWth Otott minimize my waste generation and select the best waste management mem,,,Mal is Rentable
<br /> mviI se
<br /> Customer 51 ature Data Driver ignaturg,.,.•-l_:% DaiL
<br /> Y?2tnt Name _.C�l/-�•i+ .. ., l f/ -..
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