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• SERVICE ORDER ' <br /> DIXON OFFICE Foafa NO.AEslx)ae)aEv 10ro7) <br /> 1-800-7-ASBURY SERVICE ORDER NO. <br /> MON CITY OFFICE <br /> 888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> H <br /> P ,,, „ 1-800-974-4495 ., <br /> E <br /> D TRANSPORTER EPA# CAD028277036 <br /> T i.. , . <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> TOTAL <br /> CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <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 /> DESIGNATEDTSDF: .baE. t!YE'V rt, jilIj i•!'11'!. <br /> ALTERNATE TSDF: <br /> CFR: 33210 Western Avenue, Union City, CA 94587(510)487-9277 <br /> DRUMS PN: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that the waste described above is property classified,described,packaged,marked and labeled,and is in proper condition fortranaportation,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 /> 0 #1)1 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.1 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 /> O#2)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER Nan 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 Ne additional charges <br /> for Ne disposal of this waste if the Information I have provided about this waste is incorrect <br /> O#3)This waste is from a tank which collects waste it from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESGG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIYI CESGG collection tank is soley from DIY andlor 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 /> O) If I am a large quantity generator,I certiy that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> acbcable and that i have selected the practicable method of treatment,storage,or disposal currently available to me which minimize&the present and future threat to human life and <br /> .,e environment;Or,If I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the beat waste management method that is available <br /> to me that I can afford, <br /> Customer Signature Date Driver Signature Date <br />