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FOR SERVICE CF LL: SERVICE ORDER , FORM NO AES(IOba(REV 10N7) DIXON OFFICE 1-800-7-ASBURY r SERVICE ORDER NO. UNION CITY OFFICE �! __— - illV)4::.''',6:'.•9 1-888-603-8844 — — — — ASBURY ENVIRONMENTAL SERVICES - 1300 SOUTH SANTA FE,COMPTON,CA 90221 S 1-310-886-3400 H P PPM TRAM` *01•<7i T:1C}N INC -- RPIAANSPORTER EPA#CA0028277036 E .34x1 i?ARCY aF,Fthld ,Y :)01, DARI;Y FARAWAY D p ;.':..lit,)..-;f,411 CUSTOMER# PURCHASE ORDER# ROUTE TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES .1F.F1' Il1r. Cl I J.ncl DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# �.l1.41f::'kiS4`i' Ck/9/;?v'r4 °> CAL.t3ti'i41;ic.:L'>'£1:+ PART# DESCRIPTION QTY UNITPRICE QTYPIU TOTAL CI; 11 i.-J. UIJA Hill? Lyrv:.i(1l :.NI1..'f"L*R(l -!. :6`.i YSe li d" r K 1 TOTAL /-" - CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDR WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE CODE_ OTHER: - DESIGNATED TSDF: ALTERNATE TSDF: CFR: 33210 Western Avenue, Union City,CA 94587 (510)487-9277 l DRUMS PN:_gr"^_ EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX Thla is to comity that the waste described above is properly clan allied.described,packaged,marked and labeled,and is in proper condition for transportation,according Io sill state State and federal regulations.By signing bsl ow 1 also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) D 41)1 have at mixed any of the waste described above with any other hazard...waste,the 1a1a1 hands zaniest is LESS than 1,000 ppm,and the was It does nor contain any PCBs.l nave complied with the requirements of the applicable California used oil me nagemant regu lotions to date tonere ties Is true.I agree to accept the additional charges for the disposal of all waste if Ira information I have provi dad about th I waste la Incorrect 0 02)1 have not mixed any at the waste described above with any ether hazardous waste,the late halide tante at is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I have provided proper documentation to Asbury Environmental Sam".to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional chargee for the disposal of this waste If the Information I have provided about this waste is Incorrect 0 401 This waste is from a lank which collects waste ail from household"do.it.yourself'(DIY)and/or conditionally exempt small quantity generator(CESGG)sources.To the beat or my knowledge,the only waste oil contained In my DIYI CESGG collection tank is saley from DIY and/or CESGG sources.l have not mixed this waste sit with any other hazardous waste or waste nil from ether sources.I agree to accept the additional charges for disposal of This waste if"information 1 have provided about Mia waste Is Incorrect (All generators/customers MUST read the following text and check the associated box.) 0 44) If I erg a large quantity generator,I cenify that t have a program in place to reduce the volume and toxicity of waste generated to the degree 1 bave dNarminad to be economically practicable and that I have selected Ina practicable method of Irealmenl,storage,el dbposal currently available to are whiCh minimizes the present and future threat to human life and Me .n I t Or I'am a all quantity generator,I have made a goad login effort to minimize my waste generation d select the best waste management method Mat is available (( an m " come thbt I c�Hord Customer Signature Det& - Driver Signature - Dife _&Sl Print Name Print Drivers Name