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FOR SERVICE CALL: SERVICE ORDER <br /> FORM NO AES004•6(REV 8i151 <br /> DIXON OFFICE <br /> 1-800-7-ASBURY SERVICE ORDER NO. <br /> FRESNO <br /> 559-498-0240 <br /> CHICO OFFICE <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE. COMPTON CA 90221 <br /> H 1-310-886-3400 <br /> P TRANSPORTER EPA#CAD028277036 <br /> P <br /> E <br /> 0 <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 PIU TOTAL <br /> i <br /> TOTAL <br /> dCASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,UQUID(USED OIUIMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,UQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 23285 Eichler. Ste E, Hayward, CA 94541 323-921-4784 <br /> i <br /> I�DRUMS PIU: EMPTY DRUMS: FACILITY: B S C <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that the waste described above is properly classified.described,packaged,marked and labeled.and is in proper condition far transportation.according to applicable State <br /> and federal regulations.By signing below I also hereby certify that. <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> U 91)1 have not mixed any of the waste deaulbed above with any other hazardous waste,the total halide content is LESS than 1.000 ppm,and the waste does not cometh arty PCBs.t have <br /> complied with the requirements of the appticabde California used oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal at this wsale <br /> it the information I have provided about this waste is incorrect <br /> t]0211 have not mixed any of the waste described above with any other nazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PGB*.i <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this wants was mraed with other 11 wardaus wsale.I agree to accept the addibonat charges <br /> for the disposal of this waste If the Information I have provided about this waste is incorrect <br /> p 103)This waste me from a lank which collects wset*oil ham household"do-it•yourseir,tDIY)andtor conditionally exempt small quuUity,generator ICESOGI sources.To the best of my <br /> knowledge.the only waste oil contained in my DIYI CESOG collection lank is soley from DIY andior CESOG sources.I have not mixed this waste oil with any other hazardous waste m <br /> waste di from other sources.I agree to accept the additional charges lar disposal of this waste if the information I have provided about this waste t*incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> C7"I If I am a large quantity generator,I certify that I have a program In place to reduce the volume and toalcity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of treatment.storage,or disposal currently available to me which minimizes the present and future threat to human Iiia and <br /> Me environment,Or,If I am a small quantity genwalor,I have made a good With&Mon to minimize my wawls generation and select the best waste management method that is available <br /> to me that I can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Drivers Name <br />