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SERVICE ORDER • FORM NoAES004B(REV 1a91) <br /> FOR SERVICE CALL: ,- _ SERVICE ORDER NO. <br /> DIXONOFFICE G�OO-'�I` <br /> 1 <br /> _8 <br /> 0 <br /> 0 <br /> .7-ASBURY <br /> UNION CITY OFFICE W �z <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> 1-310-886-3400 <br /> S 1rRpNSPORTER EPA#CAD028277036 1113 5NAW ROAD <br /> " UNIVERSAL SWEEPING SERVICE GP RF-SOURCES REFFERAL <br /> 'a 1113 SHAW RD STOCKTON, CA 95215 <br /> Et;F RESOURCES E(EFFERAL (1300) 647-9337 <br /> D yJ.,1� <br /> T STOCKTON, CA <br /> Q-- tf3t90} 64/-933 CONTACT NAME ORDER TAKEN BY HALIDES <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# <br /> 127 45 ERICA k�.Os i \ 000 <br /> U N 1219 MANIFEST# <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# � _•�� ) T V <br /> CAL000?_565 <•1 Y _1 ) t'�/ <br /> 9/11./"2 �005 TOTAL <br /> QTY A UNIT PRICE QTYP� . AB <br /> PART# DESCRIPTION f I <br /> WO USED OIL / MIXED OILS <br /> 1 1;35. 0035. 0 <br /> WOSC USED OIL SERVICE CHARGE <br /> F'L .ASE E:AE_t- <br /> ).2/4/ 7 FF:ft KENT �' GF' RESOURCES 4634td7Efl E3ELL C1J5iTf) Ek DERE T. LEFAfe D DRI F,k <br /> TODA' WITH ETA ANGIE - <br /> Cross, Streets; TOTAL <br /> CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> CASH REC'D:�— WASTE DISPOSAL INFORMATION STATE CODE 221 <br /> CDRUMSPAJ:— <br /> (itrilrRATOR <br /> AZARDOUS WASTE,LIQUID(USED OILIMIXED'OILS)'NO PLACARDS REQUIRED' / <br /> HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)`NO PLACARDS REQUIRED' STATE CODE_._ <br /> D TSDF: <br /> TSDF: <br /> Western Avenue, Union City,CA 94587 FACT ITY: 77 BSC <br /> EMPTY DRUMS: FACILITY:�— <br /> (iENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THEAPPROPRIATE BOX <br /> Thb is to cadi/Y that the waste described above is property classified'descdbad.packaged.marked and labeled,and Is to proper condition for ded.podabon,according to applicable State <br /> and federal regulation..ey signing below 1 also hereby certify'he': <br /> /customer MUST check ONE of the following three boxes <br /> (Waste oil generator m,end the waste does not contain any PCes.I have <br /> e1)I have not mined any of the waste described above with any albs,hazard...waste,the total halide content is LESS than .,c Pp <br /> complied with the ruhl sumonb of a s ade...be Calilm r.used oil management requlationa to determine this Is true.l agree to accept the additional charges la the diapoW of this wee a <br /> if the Information I have provided about this oras.is 1nCdr,ec[ <br /> D e2)I have not mixed any° asumption that this waste wad mired with othe,haaardo°a waste <br /> .I agree to accept Ne additional charges <br /> ofM.waste described above with any°Thar hazardous waste,the total betide content is GREATER than t elm ppm,and the waste doss not contain any <br /> s. <br /> have provided proper documentation to Asbury Envbonmenbl Sarvlce.to abut IN M <br /> about Nis won id Incorrect <br /> nerator ICESOGI sources.To the beat o/my <br /> 1°r Me disposal of Nit wets it the Inloonadon I M1rva provided.... <br /> D MDI This waste is from a lank which collects waste oil from hou.eh°Id"tlo-ibyounfro IDM ang.,GESOcondiipna-Y a% is.mall cdculdry ,. <br /> Information <br /> knowledge,e e only waste oil co°timed in my DIYI CESDG c.l.chund tank b to from DIY s dMe CESOG sources.I have not m,(ixed lLs e a atO1 J'L+^ ud waste ar <br /> waste oil from other aou,cea I agree to accept Ns atldRional charges InrMU�disposal°readf one •the following text and a� t this weed a incorrect Cu box.) <br /> (All generatots/customers ed to the degree h s deu mined to bee onomically <br /> 1"n m zefthe peas t rind lutura threat to human life and <br /> .Nit ll g I certify Nat I Ave a program In Place m reduce the volume and toziciry f ante g fi <br /> Ix MI I/I am a large gu Y 9 dtwa or disposal cm,,n ly evadable!o me whl ;e' t/gbest weer n9im gemen!method Net is avadabia <br /> nerator I have mew a good Win effort to minimize my warm gen at la° .I <br /> practicable and Net I have selected a pracdcade me ori o}b»Intent, W n ' / \ l <br /> a. <br /> the eri.1 ent Or, <br /> if I am a small antltY'i ) � � <br /> DateJ f•`! <br /> r <br /> I---� —1--"— DriveyAig ture ! <br /> "till __ Date yo, I �i <br /> Customer Signature (, <br /> f'r. <br /> Print Drivers Name ,� <br />