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,f - <br />VICE CALL: FORM, NO. AES0O4_B IRE�/JC,,`07 <br />-,DIXON OFFICE <br />i-8(10 % SSfIi�Y SERVICE ORDERINO. <br />�UNIO ,CITY OFFICE1 <br />1-888-603-8844 <br />CHICO OFFICE <br />800-733-9043 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, CO PTON, CA 90221 <br />s1-310-886-3400 <br />HI„ > #si ¢ 3 � TRANSPORTER EPA # CAD02827703604"i q�g ry`,"'%R f <br />d <br />p!�*r£ "aEh 4 may. <br />P <br />E fA0UT Ito f Ai 4' AtZ A i . Y °�.;`:hr s 3 R :P, '�wa •"% : ,�, Iw.i ro` <br />�» <br />T <br />i <br />7UST E GAS ER UTE TRUCK # CC TACT NA E ORDER TAKEN ; HALIDES <br />r' re•z"gfw= <br />w <br />E3A REARED DAT EAST ZED NEXT SERNACE DATE. CUSTOMER EPA It ABF T # <br />yM ^4 h Sat» t >d <br />PART CRIPTTCiPT`! <br />Pry <br />PRICE QTY PIU TOTAL <br />+A, P4 �'t '.11 aw 1,' <br />+�. <br />AL <br />70ER <br />YF OM THIS SERVICJ� <br />PLEASE PAYF <br />cA ; . � C' : d EC <br />ST DIS OSAL INF TION <br />-2Gi7A,F i S i ►STE, LIQUID (USES Oj[4/ IXED OILS) *NO PLACARDS REQUIRED* STAT <br />Cf3�iE 221 <br />C �!( (ETHYLENE GLYCOL SOLUTION <br />*� PLACARDS REQUIRED* STAE CGDE <br />TH <br />S1C i <br />6 <br />A"fEiATE TSaE3F: <br />FtEG CLI iG. 3 io Western Avenue, Union CRY, CA 94587 1-510a487-9277 <br />EDRU1VI.�s;PAl:"_._ EPT DRtle_o_.__ __— <br />FACILITY' -____ BS.0 <br />�; <br />(; NE AT f3 BASTE CERTIFICATION <br />PLEASECHECK THE APPROPRIATE BOX <br />according o applioable State <br />Thia is to certify that the waste described above is property classified, describekpackaged, marked and labeled, and is in proper condition for transportation, ! g i <br />and federal regulations. By signing below t also hereby certify that: k ONE f e following threeX <br />it r/c m, and the waste does not contain any PCBs. I have <br />❑ #f) I have not mixed any of the waste described above with any other hazardous waste, the total halide content is LESS than 9,000 pp } <br />is us <br />complied with the requiremendad about this waste isliancorrected oil management regulations to determine this Is true. I agree to accept the additional Charges for 14ee disposal of this waste <br />ts of the applicable <br />forn <br />if the information I have iprov <br />❑ #2) I have net mixed. any of the waste described above with any other hazardous waste, the total `halide content is GREATER than 1,000 pp <br />m, and the waste does.�not contain any PCBs. 1 <br />proper documentation to Asbury Envaronanenta! Services <br />this wast tis incorrect presumption that this waste was mixed with other hazardous waste. B agree 8o agcep4 tlaeadd¢Yional charges <br />have a disposal #rte <br />s®r the disposal of this waste of the information 1 have provided ate <br />tank es:soley from DIY and6oe CESQG sources. I have not mixed this waste oil wi8ta any oths hazardous waste or <br />-#3► This waste is from a tank which collects warts oil from household "do-it-yourself" (DW) and/or conditionally exempt small quantity generator (CESQC) sours ls. Yothe best of my <br />knowledge, the only waste oil contained in my ®ly/ GESQG collecteon <br />waste oil from other sources. l agree to accept the additional charges for disposal of this waste if fe information ion 1 have provided about this waste is incorrect <br />associateda) <br />(All generators/cUstomem MUST read, theowing <br />ext and check th <br />deten-n <br />ro ram in plea; to reduce the volume andatoxicity of vailable to ms to generated <br />h e i ted to the the degree ent and future thereat to human life and y <br />❑ ) if I am a large quantity g rater, I certify.that I have a.p 9 management m rho <br />that available <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently # <br />pea environment; Or, if F am a small quantity generator; I have made a good faith effort to minamize;my waategeneration:and select the bask waste martag # ) <br />the <br />tosrate`that I 1�an afford. <br />£ a <br />ItDriver 51 it Date / <br />, <br />(late <br />Custorn'r, Signatus a, <br />Print Drivers;Name <br />