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FOR SERVICE CALL: b _,.PERV10E ORDER FOPJA140.AES004-B(PFV)�v>) DIXON OFFICE 1-800-7-ASBURY _ SERVICE ORDER NO. FRESNO — —— 559-498-0240 CHICO OFFICE o 800-733-9043:. " ASBURY ENVIRONMENTAL SERVICES s 1300 SOUTH SANTA FE,COMPTON,CA 90221 H r r. , $ _f„ r e t )-+ . 1-310-886-3400 l iSMl�t r' • t .. %s�"I;?,v = ,� b'11 _•S�-S'1 '."r -ANSPORTER EPA#CADD28277036 P m�tii c�IjIt.r;::" !S (cRGI!",(;�L� Yt3f. kdAt}1t,1�� L��tl E T _'-t:a1.� t'�-.•KTtA i. CA Q:-, .1l CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES I f(02r �i3 r ' ::)r '7TAH I trmcmzrlus DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL vr= 1_I ED _II-..At11 lE F LT F i a TOTAL CASHREC'D: 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: 332'(0W6skeYh:AV4 6666,\U6i6Yi-City,,OA'940=487 5217. N 0`11i.C R. aft:t:.H ii,;kRO,. i'a41,s a421-4 7184 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 Slate and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) ❑ 01)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 the was le does not contain any PCBs.l have complied withthe requirements of the applicable California used oil management regulations to determine this is true.I agree to accept lire additional charges for the disposal of this waste it the information I have provided about this waste is incorrect ❑#2)1 have 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(nixed with other hazardous waste.I agree to accept the additional charges for the disposal of thiswasle If the information I have provided about this waste is incorrect ❑ 03)This waste is from a tank which collects waste oil from household'do-il-yourseir(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best or my knowledge.Ilia only waste oil contained in my DIYf CESQG collection tank is soley from NY and-for 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 addiljonai charges for disposal of this waste if the information 1 have provided about this waste is incorrect - (All generators/customers MUST read the following text and check the associated box.) ❑if9)'i(i am a large gnlity generator,1 certify that I have a program In place to reduco the volume and toxicity of waste generated to the degree 1 have determined to he economically practicable and that I ave selected the prd`clicable method of treatment;storage,or disposal can aptly available to me which minimizes the present and future threat to human life and (he environment Or it am a small quan�ity generator,l h ve 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 ffd. ILI Customer'b cin lure - Date Driver Signature Date Print Name Print Drivers Name