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FOR SERVICE CALL SERVICE ORDER <br /> DIXON OFFICE FORM NO AESOG-11IREV 10W, <br /> 1-800-7-ASBURY <br /> FRESNO _—a =—__ <br /> SERVICE ORDER NO. <br /> 559-498-0240 <br /> CHICO OFFICE <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> s 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> H 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> P <br /> E <br /> n <br /> T <br /> U <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DA E CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION TQTY UNIT PRICE QTY PIU 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 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 PIU: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> Thte is to candy that the waste tlesddbed above a property classified,described.packaged,marked and labeled,and Is n,proper condlh rn for Vanaponatlan,according to applicable State <br /> and federal reguliaj...By signing below 1 also hereby cMdy That <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 0111 have net mixed any u1 the waste described above won any other halecdous waste,the total bande content is LESS than 1.000 ppm,and the waste does not conla,n arty PCBs I lava <br /> compiled with the requirements of the epphcaW0 California used el management regulations In determine this Is true.I agree to accept the addnranal charges for the disposal of this waste <br /> if the information I have provided about in,.weals iunconed <br /> 0#211 have not meed any of the west.described of with any oIner nuarn.us waele,the total hands content Is GREATER than 1,"ppm,and the waste does not contain any PCBs.1 <br /> have prewdad proper documentetlon to Asbury Envuonmenul Serv¢ee to .but the'ro umptmn trial in..waste was meed with other hasardoua waste.I agree to accept the additional chargee <br /> for the disposal of Nie waste if tM ndwshi I have provided about this waste is Incorrect <br /> p egl Thus waste Is from a tank which collects waste oil from household 'do It-youealr IOIYI anww conditionally exempt small quantity generator(CESQG)sources.To the bear of my <br /> knowledge,the only waste Oil contained in my DIYI CESOG collection lank Is soley from DIY anNoi CESQG sources.I have not mixed this waste dl with any other hazardous waste or <br /> W"10 all from other sources.I agree to accept me additional charges for disposal of this waste 11 Na mtdemation I have provided about this waste Is ineomcl <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0 aa) If I am a large quantity generator,1 Cenlly that l hay.a program in place to reduce the volume and toxicity of waste generated to The degree 1 have determined to be economically <br /> practicable and that I have selected the practicable method of Ire tiou nL atorage,ter disposal currently available to me which minlmtles Ne present and future throat to human life and <br /> the environment;Cr,if 1 am a small quantity gimiuelw,I have made•good futh eH.n In mlmrtll2o in,waata generation and selecl the heal waste cwanagame ,malhod the.i.available <br /> to me her I can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />