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t"3K1 SERVICE ORDER FOOSi=RVICE CALL: ' bl)(O V OFFICE FOMAfro.AEsoa+a{p-v Gaon +' 1-800-7-ASBURY:°,� " T�,_. _ SERVICE ORDER N0. FRESNO - —_—— 559.498-0240 CHICO OFFICE 800-733-9043 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE,COMPTON,CA 90221 " t.1Tt-IIF ::11 (C+;-i{1+yid EGA }r`1l CT-aJCq:!<TC, 1-310-886-3400 P ;? i ,r lJ1'+;;{ i l� 'i<<.I(3C�#= TRANSPORTER EPA#CAD028277036 YJ7,7 t.I-I:i(-AMF;R 1-.AHE E s,3 art 9 f;1.Y' 0 la'I.i1 24A'1-9ej:A-,J i-W1 '4) *.Z42•�lh%J I CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES LITt 2',3 � ) ti f!I;K kcosic DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL s5'5 :�tTM `z C-3 ALL—f I;tri ivr CJR Til 'gid+i.00 UlIXED MIXF-0 PUEL1 K'ER C)i,UlO 1195 ID10 °s'•"Pi)u7 rrt s trP�t�. TOTAL CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LiQUID(USED OiLIMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LiQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: SA RECYCLING: 3321U`VJe§feYn'A�ielit+ ;[Jhloii{C�t�; 9d$87 1=51'b8y 82�1�2'•'- tl�111.4' TC C,t)1�4rJ�f?D_ + �1": 1, 2 •9x1.4 5 SGA ' DRUMS PN: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This Is to certify that the waste described above is properly classified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 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(fie waste does not contain any PCBs.l have complied with the requirements of the applicable California used oil management regulations to determine this Is true.1 agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect 0 92)1 have not mixed any of the waste described above v ith any other hazardous waste,the total halldo content Is GREATER than 1,000 ppm,and the waste does not contain any PCBs. have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the additional charges for the disposal of this waste if the information 1 have provided about this waste Is Incorrect p 0)This waste Is from a tank which collects waste oil from household"do-it-yourself"(01Y)and/or conditionally exempt small quantity generator(CESQG)sources.'To the best of my knowledge,the only waste all contained In my DIYI CESQG collection tank is coley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste it the Information I have provided about this waste is Incorrect r (All generators/customers MUST read the following text and check the associated box.) -0 A4) If I am aarge quanllty y erator,l certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically practiF�H'i e "all h e se{ cted lha practicable method of treatment,storage,or disposal currently available to ma which minimizes the present and future threat to human life and tha enor,Itma matquantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available tome affor + Customer Signature Date Driver Signature Date Print Na a Print Dr Vers'Name