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FOR SEkylqjG4�LL: S.r.--RVtr.E 0 RESE'-_ <br /> % <br /> DIXON OFFICE <br /> 1-800-7-ASBURYI C.PE b t-7 <br /> FRESNO <br /> 559-498-0240 <br /> CHICO OFFICE <br /> 800-7-33-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE, COMPTON,CA 90221 <br /> 1-310-886-3400 <br /> TRANSPORTER EPA 9 CAD028277036 <br /> P <br /> E <br /> D <br /> T <br /> CUSTOMER# PURCHASE OPE ROUTE# TPUCK# 14AME ORDER. B)lE:S <br /> Q^-TE E14TEREP P <br /> DATE REQUIRED1 NEXT SERVICE DATr- U S TO E R EF <br /> F <br /> PARI LftT PRICE 1�tU <br /> TOTAL <br /> CASH REC�0- C.K E C KF-LEASE PAY FR&* THiS SER` ORI`ER <br /> FOE`- - ­ -1 <br /> WASTE DISPOS.4tLI RMA ?ON <br /> — NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)1E 0 PiiACARDS REQUIRED' STATE CODE 221 <br /> — NON-RCRA:HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTiONS)-NO PLACARDS REQUIRECO STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue,Union City,CA 94581' 1-510-487-9277 <br /> DRUMS PIU: EMPTY DRUMS: FACILITY. BSC <br /> GENERATOR VVASTE CEIRT IFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX J <br /> This is to certify that the waste described above is property classified,descnbed,packag-L-3,marked and labeled,and is in proper condition for transportation,according to app!icable State <br /> and federal regulations.By signing below I also hereby corisfy that: <br /> (Waste oil generator/custoriler 14UST check ONE of the following three boxes) <br /> 0 01)1 have not mixed any of the waste described above with any othor hazardous waste,the total halide content is LESS then 1,00 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 far the disposal of this tvaste <br /> if the information I have provided about this waste is incorrect <br /> 0 9211 have not mixed any of the waste described above with any other nazardaus waste,the total halide content is GREATER than 1,M ppm.and the vva3le does not contain any Pces.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste w2s m'x0 with other hazardous waste I agree to accept the additio nal 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"do4t-youtseir JDIY)andfor conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil ccnta�ned in my DIYI CESQG collection tank is soiev from Oily andior CESQG Eaurces.I have nal mixed this waste ail with any other hazardous waste of <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 follovving text and check the aswIciated bcm.) <br /> &4) If I am a large quantity generator,I cc-,M-y that I have a program In place to reduce the volume and toxicity of waste generated to the degree t have determined to be economically <br /> octicable and that I have selected the practicable method of treatment storage,or disposal currently ava:!able to nv-which minimizes the present and future tftmatWhuman life and <br /> the-mykrment,Or,if I am a sinall quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management-111 <br /> to me th I can afford. — I me.I-W that is available <br /> /* <br /> Custor e <br /> —ner SignatUr Date .-F--Kw4r Signature Date <br /> ---\I r <br /> , -1 1 - <br /> Print Nain,6 Print Drivers Name <br />