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FOR SERVICE CALL: • SERVICE ORDER • <br /> DIXON OFFICE FORM No.AESooa B(REV 10/07) <br /> 1-800-7-ASBURY SERVICE ORDER NO. , <br /> UNION CITY OFFICE <br /> 1-''-1-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON, CA 90221 <br /> s <br /> H 1-310-886-3400 <br /> P ,};'�[ l..t-fY"I 1i-?"S"-' TRANSPORTER EPA#CAD028277036 'e1'a'I i1 tlrt�:" <br /> E <br /> D <br /> T !il C}!`� 1 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> I Iff'aytA t If <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> -� I,:eS. ,�p..z� .r })�'}f•7 + ,xr C1'h'.'7 ( .,I,. � +� ' -' �_' y � <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> (J0 U _0 ';if L J. {.a• <br /> TOTAL <br /> CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE 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 /> DESIGNATEDTSDR �'y iP;�ltd ei4 i1jKi+t 1N i1 'i Pt i+ _ 1 £ +fii31i f atiWS,� I <br /> ALTERNATE TSDF: <br /> CFR: 33210 Western Avenue, Union City, CA 94587(510)487-9277 <br /> DRUMS PN: EMPTYDRUMS FACILITY.-BSC— <br /> GENERATOR <br /> ACILITY: BSCGENERATOR 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 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 /> If fl)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 <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 /> 0#2)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.)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 /> 0#3)This waste is from a tank which collects waste oil from household"do-it-yourself"(01Y)andlor conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIY/CESQG collection tank is soley from DIY andlor CESQG sources.l 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 to incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) lbOv 7 <br /> p."I if I am a largd quantity generator,I certify that I have a program in plata to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> p able and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life an, - <br /> I. Anonment;Or,if I am a small quantity generator,l have made a good faith effort to minimize my waste generation and select the best waste management method that is a�a�EI( <br /> to on.that l can afford. - (� <br /> Customer Signature Date Driver Signature Date <br />