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FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE Fowa NO.AEsaCa a(REV tH7) 1-800-7-ASBURY SERVICE ORDER N0. FRESNO - _ —— 559-498-0240 ® _ CHICO OFFICE 800-733-9043 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE,COMPTON,CA 90221 H +R '�I ry, V c.r:•:,f .i i-310-888-3400 TRANSPORTER EPA#CAD028277036 ?.il;i F ;;,/-,hsP;iCt? ,hl ii P E CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# .'r•;l_;';��_t`!. __... i'il.!!::i•'i•. ��fi��t'J�f.% '::.�:I /'1 '? - _' � PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL (�'_��iai ...'!1 r.:;•i:r,1_I._ '..til. ... 'i �+ .: t l �(� TOTAL CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER _ WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HA7ARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: SA RECYCLING: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 DRUMS PN: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX 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 Stale and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) v 91)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,end the waste does not contain any PCBs.1 have nmpiled with the requirements of the applicable California used oil management regulailons to determine this is true.I agree to accept the additional charges for the disposal of this waste if the Information I have provided about this waste is incorrect D 92)1have not mixed any of the waste described above with any other hazardous waste,the total halide 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.l agree to accept the additional charges for the disposal of this waste If the Information I have provided about this waste is incorrect D 93)This waste is from a tank which collects waste oil from household"do-it-yourself-(DIY)andfor conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIY!CESQG collection tank Is soley 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 or this waste if the information I have provided about this waste is Incorrect (All generators/customers MUST read the following text and check the associated box.) 0 94) If I am a large quantity generator,I certify 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 �mracflcable and that I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human life and the environment;Or,if 1 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 to me that I can afford. Customer Signature Date(f/ Driyl_r Sign'afure Dai(e / ;�:;1 Print Name Print Drive S Name