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FOR SERVICE CALL: • SERVICE ORDER • <br /> k9 <br /> DIXON OFFICE FORRo.AEsoaae(REV 1oro11 <br /> -1-800-7-ASBURY _ SERVICE ORDER NO. <br /> UNION CITY OFFICE <br /> 4 ,.1-888-603-8844 <br /> CHICO OFFICE <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE, COMPTON, CA 90221 <br /> s 1-310-886-3400 <br /> ciIIY ur-- MANrccI) C:C)ly1 Y Aw) TRANSPORTER EPA#CAD028277036 f;3.TY of: MANTECA cl i <br /> P 2W5 C. WETMt3RE SF 100.1 W CCENY[CR S i RF.J,,. f <br /> D MON'1'FILY WO ONI-f #** i0LTD WASTE: nlv7.?::: <br /> T MANTECA, CA 95337 MAN-f E'CA, CA W53'5 <br /> n <br /> (?09) ( 1?09) 41`.56-8441.ti <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 7 <br /> C,I1664 xy11 ( 7 ) II E / 9TE..VC:" G Laken a <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> 6 <br /> 9/299/2"All 912812011 CAF41..18,S3001.65 007slC,, we I ,., <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> 5-0/T 5 GALLON 0/1' POLY BUCKETS 1x id#'t L.,'f'g) <br /> BRAIIIE BRANE LATHE SHAVTNf;'i PER, DRUM i. <br /> DIS.LSVf R 115 BUCKE'Y' CUSTOf4frR W1I.J. FILL. W 4H f3{iA 1'JJ4G3 aAF 14TLI_. FVFN L-E '+dE fHE ' <br /> Ai41:)1'HCif `S/ Y?uCN[-T (#'Fi'N 7AM -4if31 li-'T 7AM "'%'40 ON t:'R3:v)AY3 - CORP Yrrtd'ie) <br /> Gr rws Gi-cl e)e*tvCORP 'YARD <br /> TOTAL <br /> CASH REC'D: CHECK# PLEASE PAY FROM THI ERVICE ORDER <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 1-510-487-19277 <br /> DRUMS PN: EMPTY DRUMS: FACILITY: ��•. 1 BSC <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 for trans ponation,according to applicable Sta to <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 /> G 91)I have not mixed any of the waste.described above with any other hazardous waste,the totalhalide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.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 the disposal of this waste <br /> if the information I have provided about this waste is incorrect <br /> D 42)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1.000 ppm,and the waste does not contain any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges <br /> for the disposal of this waste if the information I have provided about this waste is incorrect ,. <br /> p 93)This waste is from a.tank which collects waste oil from household"do-it-yourself' (DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my. <br /> knowlediic the only waste oil contained in my DIYI CESQG collection tank is coley from DIY and/or CESGG 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 /> D 9d) If I am alarge quantity generator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have date maned to beeconomically <br /> practicable and that I have selected th pr -b cable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and <br /> the environment or f I am a small qua ty generator,Jfheve made a good faith effort to minimize my waste generation and select the best waste management method that is available <br /> to me that I can at d �// <br /> 7 <br /> Customer Signatu a C— <br /> Date Driver Signature Date <br /> I , <br /> s- <br /> ff <br /> Print Name Print Drivers Name <br />