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FOR SERVICE CALL: SERVICE ORDER 'DIXON OFFICE ,1 fP N0.AES004-B(REV 8/15) 1-800-7-ASBURY _ " 2tRk. y 't ICE ORDER NO. FRESNO 559-498-0240 CHICO OFFICE — — APR 2 U 2016 N '1 r i // 800-733-9043 /�N �/C f� ASBURY ENVIRONMENTAL SERVI IP;jl&JMRfir'Il1 S 1300 SOUTH SANTA FE, COMPTON, CR�4562J4 t1Fos)RT0ijPi)T H i(t �Ltd1~7 i�L(I lr`�IE �a"Tt.;f'd1d JF; s 1-310-866-3400 TrRANSPORTER EPA#CAD028277036 P I^.l VV Y0SF-,MITF; fruF e,14114 W YOFAE s4ITE AVE E D IVIAPJTr_,'CA, CA 915337 0 Pi 8;3.1146 CUSTOMER# PURCHASE ORDER# ROUTE# j TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# 4"1%r%{:Il is CALO(1)257621C, )1 3E t J_\-_14- PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL 1 g 100(',1 41)OIL t MIXED CA.s ail p }01.1 �,I F uil Uf•'k v€PB;MCRdUAY Fa+',Y!,t1 N_.-.-.....,...-,e, ::r"�•,..i:=r TOTAL CASHREC'D: CHECK# WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)-NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE_ OTHER: DESIGNATED TSDR, -ii It "PIN II ;j errs rs I. W ff,w Y.;la :i,lOF,1' ,-I 1-AI,caw• 1 n..-i ALTERNATE TSDF: SA RECYCLING: 23285 Eichler, Ste.E, Hayward, CA 94541 323-921-4784 DRUMS PN: EMPTY DRUMS: - FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This Is to certify that the waste described above is properly classified,described,packaged,marked and labeled,and Is in proper condition for transportation,according to applicable State and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 8W1)I have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have 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 If the information I have provided about this waste is Incorrect D 11211 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 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 Me additional charges for Me disposal of this waste if the Information I have provided about this waste is incorrect D 110)This waste is from a tank which collects waste oil from household"dolt-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESGG collection tank Is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept Me additional charges for disposal of this waste if Me information I have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) '..D Na) If I a^IIa%ge quantt�)y generator I 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 practicable jn, [hat I have selected Me practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and Me anvirolnA.4t;Or,if I amts small quantity generator,I have made a good faith effort to minimize my waste generation and select the beat whle management method that is available to me cart that 1 afford. r„ j/� / j y Cush ^"" / v4..... .. /� � _• er i nature Date Dnver.Signadure Date r, �) I •III i F }' -k E L ` Print Name Print Drife—rs Name