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FOR SERVICE CALL: - SERVICE ORDER <br /> FORMRO.AESOJ48(REV 1007) <br /> DIXON OFFICE <br /> 1.800-7-ASBURY _ SERVICE ORQER NO. <br /> UNION CITY OFFICE M13597457-888-603-8844 _= T�_ <br /> CHICO OFFICE <br /> F 800-733-9043 <br /> f ASBURY ENVIRONMENTAL SERVICES <br /> s 13(l0 SOUTH SANTA FE,COMPTON.CA 90221 <br /> x 1-310-888-3400 <br /> I T11,301M) WEST COAST LUMBER L.LCTR*NSPORTER EPA#CAD028277036 RSSE INC -- RS5001 <br /> E 35 N. CHL:ROKEF: (.AIME 8203 TWIN Vll%W BLVD <br /> 0 <br /> o LODI. CA 95240 REDDI NG, CA 96003 <br /> (253) 896•-8700 (530) 241-1275 <br /> CUSTOMER# PURCHASE ORDER# jR0UTE#j TRUCK# I CONTACT NAME ORDER TAKEN BY HALIDES <br /> TE13697 94 HP 7'I'IERCd RSSE -akei.il <br /> DATE REQUIRED DATEENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> 10 /18/2011. 10/17/2017. CAR000142463 <br /> PART# DESCRIPTION QTY UNITPRICE QTY PIU I TOTAL <br /> ow OILY WATER. PER GALL <br /> rRECEIVED <br /> JAN <br /> 2 8 2014 <br /> HEATHER Q RSSE 530-'241=1275ENVIRONMENTAL <br /> Cr r ss Streetst (SHELL.,) HEALTH DEPARTMENT . <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).eNOPLACARDS REQUIRED' STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE,GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE;CODE_ <br /> OTHER: <br /> DESIGNAtED TSDF: <br /> ALTERNATETSDF: <br /> SA RECYCLING: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> DRUMS PN: EMPTYDRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION - <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> Thia lstocodifythattonwaste duanWdsb Velapfopodycloellned,desedbed,packaged,marked and labeled,and is In propercanditlon forlragspertation,according Ioapplicabh State <br /> And tedaral regulellons.ey.haring below I els.hereby to afy Mal: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 oil l have not misetl any of Ne waste descdbetl above with any afar hanrdous.a,ta,the total halide conlenl is LESS than 1,000 ppm,and the wash does not cantaln any P08s.1 have <br /> compiled with the raqulfemnde of the sppliaablo California used all mnagement tagulallons to determine this Is thus.I agree to accept the aadilional charge,far the disposal of this waste <br /> It the Information t have provided about this waste is ineuriecl <br /> 0■aj I have not mIxgd any of the was is described above with any other nezardeua waste,the tab[halide content Is GREATER than 1.000 Dona.and the waste does not contain my PCBs.I <br /> have provided proper dpeomenbgenm gabury Environmental Services to rebut lhapresumption that this waste was mixed with olherhaaaedoua wa,to.imteslaaccepttheadddmdchatges <br /> for the deposal at Ihla weals It the Information I have provided about fl,wasfa is Incorrect <br /> p qg)This waste is from a tankwhloh caWciawaste an from household'doaPyouneir pyj mdror conditionally exempt strail gesmliy generator(CESQGi aaurces.To the bestof my <br /> ""[edge,the only waste oil contained in my DNI CESQG collection tank Is Foley from ON ampur CESGG sources.I have not Mud this waste all with any other hazardous waste or <br /> wawa oil from what sources.I agree to accept the addidmQeWrges tar disposal of this west*If the Information I have provided about this waste In incorrect <br /> (All generators/customers MUSE'read the following text and check the assodated box.) <br /> 0,14j litems large quantity generator,I certify that l have a program in place to mducs leaa volumo and toxicity of waste generated to the degree l haws delerminad to W econamically <br /> practicable and fel l have s hiclod the practicable mslhod of treatment,storage,ori[spolalcunardly aval[able to rM which madmiaesdhe present and future threat to human Ida and 4 <br /> -themvbonmanq Oyiilamasmall quantiy generatumlhare madeagood lalth elfod la Mnlmiae my waste generaltan end esteeilb teal waste managoaenf Mod Mal is avagable <br /> to me lM1all ten agora. f <br /> ILL'1L Lair <br /> CUE;6�@r Signature Date D i nature ate <br /> Print Name Print�Drivers Name <br />