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FOR SERVICE CALL: SERV)CEQRICIER • DIXON OFFICE FORM NO.nesooae( 10107) 1-800-7-ASBURY SERVICE ORDER NO. UNION CITY OFFICE _ - 1-F`603-8844 w c = ASBURY ENVIRONMENTAL SERVICES s 1300 SOUTH SANTA FE, COMPTON,CA 90221 H 1-310-886-3400 I „IT F '5' : :l ?l t ?7 TRANSPORTER EPA#CAD028277036 f;h4iilNt ltl11 � (s ' e Ort 'rd Q : i r-t"+k;t. 1471, E3PIL`R S' D TiT47 i3C f !t7Hy'f#rii TWESi t:A F F"yfkt l 6aJfil ll f't'i, � O ('209 'J+triaa6042 .. t.`'7yttl) 3715-11%13 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES WN DATE DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# i., . 414 ":r' 4.J GAL 0031 <r46 y.'{ a (C PART# DESCRIPTION QTY UNIT PRICE QTYPIUJ TOTAL QSEUr OTL� g .Vt TOTAL CASH RECD: CHECK# ' - PLEASE'PAY FROM THIS`SERVICE ORDER WASTE DISPOSAL INFORMATION : NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)-NO PLACARDS REQUIRED* STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE OTHER: x ”DESIGNATEDTSDR I'>k U A GHQ: Yt1 ; 4drii, U fl, , d;4 ' Q. a-7797 �- #Ce ;sit :vxiil _'i3cS ALTERNATE TSDF: CFR: 33210 Western Avenue,Union City, CA 94587(510)487-9277 DRUMS_P_N:_ TYDRUMS: _.,FACILITY:_ BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX 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 -and federal regulations.By signing below I also hereby certify Meh (Waste oil generator/customer MUST check ONE of the following three boxes) ,b #1)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 Me additional charges for the disposal of this waste if the informations have provided about thin wastatajnSpzrect O#2)I have not mixed any of the waste described above with any other hazardous waste the total halide content Is GREATER Man 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.)agree to accept the additional charges for the disposal of this waste If the Information I have provided about M13 waste is incorrect - p#3)This waste is from a tank which collects waste oil from household"do-It-yourself(DIY)andfor conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,the only waste oil contained in my DIYI CESOG collection tank is soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.i agnea to accept the additional charges foidsposal of this waste If the Information I have provided about this waste ie incorrect (Ali generators/customers MUST read the following text and check the associated box.) 0'- "`I am a large quantity generator,l certify that 1 have a program In place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically pr. 4e and that t have selected the practicable methad of treatment,storage,or disposal currently available to me which minimizea the present and future threatto human life and - the,. mnmenl;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation aid select the beat waste management method that is available to me Mat I can afford I Customer Sig' attire Date Driver Signature Date 4;1,