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E V <br /> FOR SERVICE CALL, SERVICE ORDER <br /> DIXON OFFICE FORM NO.AES0W-8(REV 10(07} <br /> 1-600-7-ASBURY sUN 1.2 205 SERVICE ORDER NO. <br /> FRESNO = r <br /> 559-498-0240 - T <br /> -dVVIRONMENTAI - -_- <br /> o — <br /> CI-IICO OFFICE 1r. tit. <br /> 600-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> s 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> 1-310-886-3400 <br /> o TRANSPORTER EPA#CA0028277036 <br /> Q <br /> O •' :a-, .,-,"+'... . '..i.:%_�; r'i�I�;�'s(,"r1 .,.ilat•ii�''' �'�^'p" i <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> A„r� <br /> k � r tM :•3�11,�r1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST"## <br /> G Y <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> +'•�.. is':��:%'�'.'1i„, :4:Nr!t.�.;:ir” .. <_.,:: i+' 'r:!.t�Qi..'t <'�' <br /> ��, 5> _! °;x 1;= TOTAL <br /> CASHREC'D: CHECK#t PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILSj*NO PLACARDS REQUIRED`" STATE CODE 221 <br /> NON-RCRA'HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)"NO PLACARDS REQUIRED` STATE CODE <br /> OTHER; ' <br /> DESIGNATED TSDF: �' }; �+ a t,r.•.( r, r' <br /> ALTERNATE TSD1F <br /> El SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-510.487-9277 <br /> DRUMS PIFU: EMPTY DRUMS. FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to oertify that the waste described above IS properly classified,described,packaged,martced and labeled,and Is in proper condition for transportation,according to applicable State <br /> and federaf regulations,By Signing below I also hereby Certify that: <br /> (Waste oil generator/customer MUSTcheck ONE of the following three boxes) <br /> #1)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 <br /> c plied with the requirements of the appllcahle California used oil management regulations to determine this IS true.I agrae to adept the additional charges for the disposal of this waste <br /> It the Infonnatfon I have provided about this waste Is tncorreet i.. <br /> ❑N2)1 have not mixed any of the waste described above with any other nazardoua waste,the total halide content is GREATE=R than 1,000 ppm,antl the waste does not contain any p066.I <br /> have provided proper documentation to Asbury Environmentalaz <br /> Services to rebut the presumption that this waste was mixed with other hazardous waste-I agree to accept the additional charges <br /> Tor the disposal of this waste if the Information E have provided about this waste is incorrect <br /> p 83)This waste is from;tank which collects wsnle oil from housahold"do-It-youraeir(DIY)and/or conditionally exempt small quantity generator(CE5013)Sources.To the beat of my <br /> knowledge,the only waste oil contained in my DIY!CESQG collaction tank Is Soley from DIY andlor CE5QG aources.1 have not mixed this waste oil with any other hazardous waste of <br /> v,nete oil from other sources,t agree to accept the additional charges for disposal of this waste it the Inrormattoo 1 have provided about this waste is incorrect <br /> (ATI generators/customers MUST read the following text and check the associated box.) <br /> If 1 am a large quantity generator,I eeruty that I have a program in place to reduce the volume and.toxlclty of waste generated to the degree I have determined to be economically <br /> pr®efieable and that I have selected ttie practicable method of traaaoent,storage,or disposal currently available to me which minimizes the pro, it and future threat to human life and <br /> the environment;Or,If I am a Small quantity generator,I have made a good faith effort to,minimize my waste generation and selor the beat wedt4 management method that is avafldble. <br /> to me thA I Tran afford. <br /> Custaft er Signature ` Date Driver Siggat ra Date <br /> Print Name <br />