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FOR SERVICE CALL: • SERVICE ORDER • FORM NO.AES004B(REV 10107) DIXQN OFFICE 1-OW-7-ASBURY SERVICE ORDER NO. OE9 59-498-0240 m CHICO OFFICE 800-733.9043 ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE,COMPTON, CA 90221 " fa1,11�,.TFf(.1G'h' REP ! ItdG 1-310-886-3400 P 1.`4$:E MiliFER »ve'. TRANSPORTER EPA#CAD026277036 *S09 MRAERAlt E P E D 0 ."M9if.,, CUSTOMER# PURCHASE ORDER# ROUTE* j TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES Cauti)-:A cu j AK`y` DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# Z. x.46 , -+; ^i i? n,� ktr d�� PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL c i'Psi 5r, +.s srL .t1 a"t ;;4�- 'hUL.; +rdk ;;111:3iTi,'.+fIED? =s'" v^'t 0'i $..7i.1.-G Y :iL`t' yC.'L�'.r'I`S PER DRUM ��' y..,..7.'.1�. 'r•0 SAP DUE a_ I ITOTAL 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: DESIGNATED TSDF: ALTERNATE TSDF: SA RECYCLING: 332"d 4 -Y1'bbh6 ;'4�iRi8t't -LeP� 7`-°?L fi $' +J �d.,281 EICHLER 4-,rE E.H.4Y%NAfk1. o.',a4-443v -'1 DRUMSPN: 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 Slate and federal regulations.By signing below I also hereby Certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) D 91)1 have not mixed any of Na 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 1 have provided about this waste is incorrect 0#2)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,090 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 Me disposal of this waste If the Information I have provided about this waste is incorrect 0 0)This waste Is from a tank which collects waste oil from household-do4byourseir(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contain"in my DIY/CESQG collection tank is soley frp a DIY and/or CESQG sources.I have not mix"this waste all with any other hazardous waste en waste oil from other sources.I agree to accept Me additional charges for disposal of this waste if Me information 1 have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) 94) If I am a large quantity generator,I certify that 1 have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected Me practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment;Or,If I am a small quantity generator,!have made a good faith effort to minimize my warp generation and select the best waste management method that is available to ma,that I can afford. Customer Signature Date Dri VFSiynature Date oa Print Namp Print nrivare Name