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FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-7-ASBURY <br />FRESNO <br />559-498-0240 <br />CHICO OFFICE <br />800-733-9043 <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />H 1-310-886-3400 <br />6 TRANSPORTER EPA # CAD028277036 <br />p <br />O <br />0 <br />10HM N0. AES004-81 REF 815 <br />SERVICE ORDER NO. <br />CUSTOMER # <br />PURCHASE ORDER # <br />ROUTE#j <br />TRUCK # <br />CONTACT NAME ORDER TAKEN BY <br />HALIDES <br />DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA # <br />MANIFEST# <br />PART # DESCRIPTION <br />QTY UNIT PRICE <br />QTY PIU TOTAL <br />TOTAL <br />CASH RECD: CHECK # " ".-' 70 <br />_ <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) -NO PLACARDS REQUIRED- <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' <br />OTHER: <br />STATE CODE 221 <br />STATE CODE <br />DESIGNATED TSDF: <br />ALTERNATE TSDF: <br />SA RECYCLING: 23285 Eichler, Ste. E, Hayward, CA 94541 323-921-4784 <br />DRUMSPIIJ: EMPTYDRUMS: FACILITY: BSC <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />This is to certify that the waste described above is property classified, described, packaged. marked and labeled. and is in proper condition for 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 />0 #111 have not mired any of the waste described above with any oMet hazardous wants, the total halide content is LESS than 1,00(i ppm, and in. waste does not contain any PQB.. I have <br />complied with the requirements of the applicable California used oil management regulations to determine this Is true. I agree to accept the additional charges for Me disposal of this waste <br />if the information I have provided about this waste is incorrect <br />0 9211 have not mined any of the wasFiyescribed above with any other Incautious wave, the total halide content is GREATER than 1,000 ppm, and the waste does not contain any PCBs. I <br />have provided proper documentation iaXsbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste. I agree to accept Me additional charges <br />for Me disposal of this waste if the infermation 1 have provided about this waste is incorrect <br />0 #]) This waste is from a fink which collects waste oil from household "dcxat-yoursslr' (DIY) addict conditionally exempt small quantity generator (CESQG) s.loss. To the host of my <br />knowledge, Me only waste oil contained in my MYI CESQG collection tank Is Galey from DIY author CESQG sources. I have not mixed this waste oil with any other hazardous waste or <br />waste oil han other sources. I agree to accept Me additional charges for disposal of this weal. if Me informvion I have provided about Mis waste is incorrect <br />(All generators/customers MUST read the following text and check the associated box.) <br />,0 ##1 If I am a large quantity generator, I certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected Me practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future Mines to human life and <br />In. environment; Or, It: am a ...it quantity gan... for , I have made a good faith effort 10 minimize my waste generation and select Me best waste management method that is available <br />le me that I can afford. <br />CustomerSignature DateDt1�Gr'S`ignaWr� _ Date <br />Print Name Print Drivers Name <br />