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F IRSERVICECALL. 's.. SERVICE ORDER "" <br /> DIXON OFFICE <br /> 1..800-7-ASBURY rnRk!mn eE>IY.IdFrncy rnm,7 <br /> UNION CITY OFFICE <br /> SERVICE ORDER NO. <br /> 1-888-603-8844 _ _— <br /> CHICO OFFICE — y— <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> H 1300 SOUTH SANTA FE.COMPTON,CA 90221 <br /> 1-310-886-3400 <br /> P TRANSPORTER EPA#CAD028277036 <br /> E <br /> i 0 <br /> T <br /> e <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# ;CON;TACT;NAIME ORDERTAKENBY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATEA EP;A# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED `ITS)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED- STATE CODE <br /> OTHER: <br /> DESIGNATED TSOF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 <br /> DRUMS PN'. EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that the waste described above Is properly classified,described,packaged,marked and labeled,and Is in proper condition fpr ban.portabon,aaommq to applicable Stale <br /> and federal regulation..a,signing below I also hereby certilY that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 01)1 have not m,.ad any of the W.described above with any other hazardous waste,the total hand.cmrlmd ie LESS than 1,000 ppm,and'be..is aloes not corium any PCBs.I have <br /> 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 prices waste <br /> If IM i.lprmaoon I have provided about this waste Is incortect <br /> 0 9311 have not mixed any of the waste described above witn any.flier nazpdous waste,the Intel halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services tat rebut the presumption that this waste was mixed In nine,hazardous waste.I agree to accept the additional charges <br /> Joe the disposal of this waste If the informal on I have provided about this waste is incorrect <br /> p 031 This waste is from a tank which collects waste oil from household-dp-,t inn.,rr eiy1 i n0ior cond...mod,exempt small guzo o,generator(CESCGI sources.To the Oast of my <br /> knowledge,the only wade oil contained in my OIYI CESCG collet bon lank is sole,from Orr anther CESoo spurt as I have not mixed this waste of with any other hazardous waste or <br /> waste oil from other sources.I agree to accept Me additional charges for disposal of thus waste If the information I have provided Abdul this waste is Inc infect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0 94) If t am a large..arbly general.,I certify that 1 have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> ,urop. ble and that I have selected Me p x1ficade method of lrcaMent,storage,in disposal cunenlly available to me which mimmizes the prmenl.,,it future threat to home.life and <br /> the edononmeN,Or,.11 am a small guenbly generator,l have meds a good faith then to minimize my waste generation and select the best waste management method the,is a 11.1ole <br /> to me met Ica.anon. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />