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FOR SERVICE CALL: SERVICE ORDER <br /> FfjR{wlflf) hL`,f;MwLataa'-I'n <br /> DIXON OFFICE <br /> 1-800-7-ASSURY 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 /> D <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 /> TOTAL <br /> CASHREC'D: CHECK# PLEASE PAY FROM M THIS_ SERVICE ORDFR <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED 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 /> This is to codify that the waste descnbed above is properly classified.described packaged.masked and labeled,and is in proper condition Icir transpunation,according to applicable Stale <br /> and federal regulations.By signmg below I also hereby cenefy that. <br /> (Waste oil generator/customer MUST chedi(ONE of the following three boxes) <br /> 11 41)1 have not mixed any of the waste described above with any other hazardous waste,file total halide content is LESS than 1,040 ppm,and Ilia waste does not contain any PCBs.I have <br /> complied with the requuemams of the applicable California used oil management regulations to determine this In true.I agree to accept the additional charges far the disposal of this-8110 <br /> If the information I have provided about this waste is incorrect <br /> 4211 have riot mixed any of the waste described shove with any other nazardous waste,the total halide content is GREATER Inan 1,000 ppm,and the-Asia does not contain any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was moxod with other hazardous waste.I agree to accept.the additional charges <br /> for the disposal of this waste of the information I have provided about this waste n incorrect <br /> 0 93)This waste is from•tank which collects wide oil from household"do-it-yourself"(DIY)andior conditionally exempt small quantity generator(CESGGI sources To the beat 01 my <br /> knowledge,the only waste all contained in my DIYI CESQG collection tank is Soley from[MY andior C£SOG sources I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste Is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> Q 041 If I am a large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> pfachcsble and that I have selected the practttable method of treatment,storage,or disposal currently aveitable to me which minimizes the present and future threat Io rid <br /> human life A <br /> the env,ronment;or,if I am a small quanlity generator.I have made a good faith effort to minimize my waste generation and select the bast waste management method that Is evallable <br /> to me that I can afford <br /> r—X _7 <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />