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FOR SERVICE CALL SERVICE ORDER FORM NO AES004 H(REV INI) <br /> DIXON OFFICE <br /> 1-800-7-ASBURY _ SERVICE ORDER NO. <br /> FRESNO <br /> 559-498-0240 <br /> CHICO OFFICE <br /> 800-7339043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE.COMPTON.CA 90221 <br /> n 1-310-886-3400 <br /> P TRANSPORTER EPA It CAD028277036 <br /> P <br /> E <br /> c <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HAUDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> i <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER - <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,UQUID(USED OILIMIXED OILS)'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: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 <br /> DRUMS PN: EMPTYDRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> Thla is to certify that the waste described above to properly classified.described,packaged,marked and labeled,and Is in proper condition for transportationaccording Inapplicable Slate <br /> and federal regulations.81 signing below I also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> G at)I have not mixed any of the waste described above with any other hacardous waste,fro total habde convent a LESS to..1 008 ppm,and the waele does not contain any PCS..I have <br /> compll d Willi the requi me„4 of me applicable California used oil management regulations to determine this 1s hue I agree to accept he additional charges for We disposal of this waste <br /> If the Informal I have provided about pis waste is incorrect <br /> D e2)I have not mixed any of the waste described above with any otin,natardu 1.waste,the total hands content Is GREATER than 1,000 ppm,and the wasm does not contain any PC8s.I <br /> have provided props,doc.overu tion to Asbury Environmental Services to .but Me pr...Pit—that this waste was agxed with other hazardous waste I agree to accept the additional charges <br /> for the disposal of this watt@ If the mformahan I have pfovlded about In.waat.is incur Oct <br /> 0 s])This wane le from a tank which collect-well.VII from household-do-it y..r..ir troy) ndox onditionally exempt small quantity generator(CESQGI sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY'CESOG collection tank is soley from DIY and/or CESQG sources.I have not mind Nis waste oil with any ower hazardous wane or <br /> waste oil horn other sources.I agree to accept the additional charges for disposal of this waste If the m4comabon 1 have provided about this waste Is incdrrod <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> G ea) 81 am a large quantity generator.I certify that I have a program In place to reduce the volume and toalcny of waale generated to the tlagna I have determined to be econom2ally <br /> practicable and that I have selected the praabceble method of treatment,storage,or disposal currently available to me which mimmieat the present and Inture threat to human life and <br /> the aovnmmern;Or,d I am a.mall quantity generator,I have maM a .it faith effort to mm.,t.my waste g mnumn and select the Den write man...menl method Mat la avul.w. <br /> to me Mu 1 can afford <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />