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FOR SERVICE CALL: • SERVICE ORDER . <br />DIXON OFFICE <br />1-800-7-ASBURY FORM NO. /,ES1704-B (REV tONn <br />SERVICE ORDER NO. <br />UNION CITY OFFICE <br />1-888-603-8844=- <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA # CAD028277036 <br />CASH <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 />CFR: 33210 Western Avenue, Union City, CA 94587 (510) 487-9277 <br />EMPTY DRUMS: FACILITY: <br />PLEASE CHECK THE APPROPRIATE BOX <br />This is to certify Mat the waste described above is properly classified, described, packaged, marked and labeled, and is in Proper condition for Vansponadon, 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 />#111 have not mixed any of the waste described above with any otherhazardous waste, the total halide content is LESS Man 1,000 ppm, and the waste doe. not contain any Kill. 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 forth. disposal of this waste <br />if Me information I have provided about this waste is incorrect <br />0 #2)1 have not mixed any of the wade described above with any other hazardous waste, the total halide content is GREATER than 1,000 ppm, and the waste does not contain any PCs.. 1 <br />have provided proper documentation to Aabury Environmental Services to rebut Me presumption that this waste was mixed wAh other hazardous <br />for Me disposal of this waste if the information I have Provided about this waste fa incorrect waste. l agree to accept the additional charges <br />0 #3) This waste is from a tank which collect; waste oil from h .... held "do -ft -yourself" )DIY) imulkw conditionally exempt small quantity generator )CESQG) sources. To the best of my <br />knowledge, the only weds oil contained M my DIY/ CESQG collection tank Is Soley from DIY and/or CESOG sources.) have not mixed this waste oil with any other hazardous waste or <br />waste oil from other sources. I agree to accept Me additional charges for disposal 01 this waste if Me information I have provided about this waste is incorrect <br />(All generators/customers MUST read the following text and check the associated box.) <br />0 #4) if I am a large quantity generator, I certify Mat 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 />Practicable and that 1 have Selected the practicable method of lreeboen4 $image, w disposal currently available to me which minimizes the present and future Mreat to human life and <br />the environment; Or, if IAm a small quantity generator, ) have road. a good faith effort to minimize my waste generation and select the best waste management <br />an afford. method that is available <br />to me Mat l c <br />Customer Signature <br />Print Name <br />Date <br />Driver Signature <br />Print Drivers Name <br />—y —i <br />Date <br />