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FOR SERVICE CALL: • SERVICE ORDER • FORM NO AES004B'REV 101071 DIXON OFFICE 1-800-7-ASBURY7 SERVICE ORDER NO. �2e-r'� D N1 I.?,iOI6 UNION CITY OFFICE rn100�, �' ` ' 1-888-6038844 ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE, COMPTON, CA 90221 s 1-310-886-3400 I UNIVERSAL SWEEPING SERVICES TRANSPORTER EPA#CAD028277036 E1113 SHAW RD 1113 SHAW ROAD DGP RESOURCES REFERRAL GP RESOURCES REFERRAL T . .£iTE1CKTOh1.r..C� .952f`.5- .. _ ...... `3TOL:KTON., CA_._95 -15 o.._ {1G10) .54/7-9337 (000) 647-9:337 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES UNI:1.9 27 S )NGIE 3kr�la <>CJ00 DA REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# 9/2010 AL.0002`6FS12 OOS o2 t'_r_ PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL/ WOSC USED OIL SERVICE CHARGE 1 ;4,5. 00 4-5. 00 WO USED OIL / MIXED OILS : r44} 0. 00 300` 0. X30 1214/0 PER KENT @ GP RESOURCES TO BILI_ CUSTOMER DIREC , L-R*-M Crc ,s ^ati-eetsa PAGEI DRIV,.F TOTAL CASH RECD: CHECK# . PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED CIU/MIXED OILS)-NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE OTHER: DESIGNATED TSDF: x 'OAT' h ' -n ALTERNATE TSDF: CFR: 33210 Western Avenue, Union City, CA 94587 (510)487-9277 , DRUMS PN: EMPTYDRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to codify Mat Me 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.sy signing below t also hereby codify that (Waste oil generator/customer MUST check ONE of the following three boxes) 01)l hese not mixed any blithe 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.1 agree to accept the additional charges for the disposal of this waste if Me information I have provided about this waste is Incorrect G 4211 have not mixed any of the waste deecdbed above with any other nazardous waste,the total halide content is GREATER than 1.000 ppm.and the waste does not contain any PCBs.I have provided .per documentation to Asbury Environmental Services to rebut Me presumption that this wash was..ad with offer hazardous waste.I agree to accept Me additional chargee for Me disposal of MIs waste if the Information I have provided about this waste is incorrect % p#3)This waste is from a tank which collects waste oil ham household'd.�h-younalf'(0IYI and/or condili.nelly exempt small quantity generator(CESQGI sources.To the beat of my knowledge,the only waste oil contained in my DIYI CESGG collection tank is coley from DIV andfor CESGG sources.I have not mixed this waste oil with any other hazardous waste or/ waste oil from other sources.I agree to accept Me additional charges for disposal 0,Me waste if Me information I have provided about the waste is incorrect (All generators/customers MUST read the following text and check the associated box.) #a) If I am a large quantity generatoq I certify that 1 have a program in place to reduce Me volume and toxicity of waste generated to the degree I have determined to be economically ractieabla and that 1 have selected Me practicable method of vestment,storage,or disposal currently available to me which minimus.the prosent and future threat to human life and the environment:0,,,f I am a amal quantit 9speriror,I have made a good faith effort to minimize my waste generation and select the beat waste management method that is available to me Mat I can afford. -+�' .- __ ' - Customer Signature Date Driver Signature/ Date 0u5/EAI