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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE FORM NO AEsooa-e 1aEv 10/071 1-800-7-ASBURY REC IVE®== SERVICE ORDER NO. UNION CITY OFFICE 1-888-603-8844 _—_ __ _ I�,,.-•;;; CHICO OFFICE AUG 2 3 2013 800-733-9043 �ttt�� ENVIRON Ivy ENVIRONMENTAL SERVICES S HEALTH DEPAFF SANTA FE,COMPTON, CA 90221 " �d4;'D 1,11 ENTERPRI1-310-886-3400 SER LLti • L4T!i�tv� AC lT {,lfCll rl17ek2Pt�IScS LLC • A+1'Ite p TRANSPORTER EPA#CAD028277036 P '51 EY.,At Y PKWY �. I:vS,F cix 814138 E T LA7HR6P OA Ka?,. I STO" KT_H C& 95215 ° i 209) 99,1 F&3995 i l% alt;j_a "JL CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANI . ST# y PART# DESCRIPTION QTY UNIT PRICE QTY P/0 I TOTAL ETHYLENE 31LYCOL SOLUTIONS 5d, Y `:r`5 s ciCc>•et5 TOTAL CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED* STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED* STATE CODE,:'•_ OTHER: DESIGNATEDTSDF: P, 2 et t&73 r '410iiy' ^CB" ALTERNATE TSDF: SA RECYCLING: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 DRUMSPIU: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to certify that the waste described above is property classified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable Stale and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 0 411)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 complied 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 if the information I have provided about this waste is incorrect 0#2)I 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 have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for due disposal of this waste if the information I ttevp provided about this waste is incorrect 0 113)This waste is from a tank which collects waste oil from household"clo-it-yourself•(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIYI CESQG collection tank is soley from DIY and/or CESQG sources.)have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste tithe information I have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) AM1) 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 degniiy I have determined to be economically acticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the prel:ept and future threat to human life and the environment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the bestwasteti anagemenl methotl that is available to me that l can afford. //!! / Customer Signature • Date' Driver S ure % Date Print Name Print Drifters Name