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SERVICE ORDER <br /> DIXON OFFICE 'ORMNO.AES004-B(REV 10107) <br /> 1-800-7-ASBURY 0 0 SERVICE ORDER NO. <br /> UNION CITY OFFICE <br /> '-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON CA 90221 <br /> H <br /> I : ; ' -1 L UPF It t 1-800-974-4495 <br /> p <br /> P <br /> E <br /> D TRANSPORTER EPA# CADD28277036 <br /> T <br /> 0 1 OGI� ()if,Cft t k Glo <br /> CUSTOMER# PURCHASEORDER# ROUTE# TRUCK# CONTACT NAME ORDERTAKENUT7 HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> 71 <br /> TOTAL <br /> —ASH REC'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 /> EDTSDF: t <br /> DESIGNAT <br /> ALTERNATE TSDF: <br /> CFR: 33210 Western Avenue, Union City, CA 94587(510)487-9277 <br /> DRUMS PN: EMPTYDRUMS: 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 for transportation,according to applicable State <br /> and federal regulations.By signing below I also hereby codify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> b NI)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 was(e <br /> if the Inflonanation I have provided about this waste is Incorrect <br /> 0 92)1 have not mixed any of the waste described above with any Other hazardous waste,the total halide content is GREATER than 1,000 plant,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 charge. <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 bank which collects waste all from household (DIY)..dfor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained In my DIV/CESQG collection tank is coley from DIY and/or CESoG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.)agree to accept fire 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 /> 0") If I am a large quantity generator,I codify 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 <br /> Icticable and that 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 <br /> environment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation And select the best waste management method that is available <br /> .a me that I can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />