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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE FORM NO AES004 9lpEv IUQ7) <br /> 1-800-7-ASBURY SERVICE ORDER NO. <br /> FRESNO d tt3 <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 /> aTRANSPORTER EPA#CAD028277036 <br /> E <br /> D <br /> T <br /> O <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(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 1-310-487-9277 <br /> DRUMS PN: EMPTY DRUMS: FACIUTY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that Me waste described above is I ivr ady classified,described,packaged,narked and labeled,and is In proper condition for t omMonalmn,according to applicable Stale <br /> and tied eul r.,ultalon. By suMmg below I also hereby county that <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 of)I have eel maned any of the..are described above with any other horrid...weal.,the total babes conlent is LESS than 1,000 ppm,and the waste does nor contain any PCBs.I have <br /> sopped with the risr,ni mints of the applicable California used ml management regulations to delmmme the b true I agree to accept the audm...I charges for Me disposal of this waste <br /> it the Information I have provided about this wants Is incorrect <br /> 0 e2)I have not mixed any of In.wool.din..bed above..in any other niiii us waste,the Inial halide content la GREATER than r poo ppm,..it lbs waste does not con4m any PCBs.I <br /> have prnvded proper documentation Io Ae Wry Environmental 5ernces m abut Me W exumptoll that this waste was mixed with other hazardous weal*.I agree to accept the addurchal charges <br /> ler the disposal of this-.start the mf.mahon I have provided.born this waste is mcornn <br /> p q)This west.le from a lank which collects wnta oil Irom h....hold"do-d younelrIDIY)andfor condumnally.rempl small quantity Wuhh.,,,ICESOGI sources.To the best of my <br /> knowledge Me only waste oil contained in my,DIV CESQG collection tank Is sdisy from 01Y..We,CESOG sources.I have not mlaetl this waste oil with any other hazardous waste or <br /> waste oil from otner sources.I agree to accept Me roodo"'charges for deposal of Mia west-It Me intamahon l have provided about Mrs waste a rnconect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> U a4) If I am a large quantity generator,l certify that l have a program in place to reduce the volume and toxicity of wasle generated to the degree I have daarmmed to be emnomtrany <br /> practh able and that l have selected Me practkeble method of treatment,storage,or dsposaf currently available to me which minimizes the pri l and future threat to human lite and <br /> the envuonmem;Or,II I em a small quanta,gin nium.I have.mads is good frith often to hantmH-my warts o mania on and select the beat waste managemenl method that is availaNe <br /> to me that I can chord. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />