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QBC-03-08 13:37 From- K Dixor"-" 17076782339 T-445 P-002/009 F-886 <br /> FOR SERVICE CALL: �CKY14G v�►.r�n <br /> FORM N0.AES004.6(REV IOA7) <br /> DIXON OFFICE SERVICE ORDER NO. <br /> 17-ASBURY <br /> UNION CITY OFFICE N G 9 5 501 <br /> 149*4034M" 10 <br /> ASI3URY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 80221 <br /> Is 1-310486-3400 <br /> P TRANSPORTER EPA SOWETY KL.EEM CORPORATE <br /> BOBS LUPE b. OIL <br /> P 1403 COUNTRY CLUB 120 PROSPEROUS PLACE , 1 <br /> E <br /> D <br /> o STOCKTON, CA 95204 LEXINGTON, KY 40509 <br /> (269) 943-0748 (859) 264-0257 <br /> C TOMR S PURCHASE RDER X ROUTE* TRUCK* CONTACT NAME ORDER TAMER BY HALIDES <br /> BUB604 - 127 71!� SCHEDULED <br /> tkATIE DATE EN RED NEXT SERVICE DATE CUSTOMER EPA iia �^ MANIFESTS <br /> 5/8:2000 5/e/2009 <br /> CAD982357717 � 3730 <br /> PART 0 DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> wp USED OIL / MIXED •UILS I )000 <br /> WOSC USED-OIL SERVIICe CHARGE, <br /> Cr >Tms.7Si"reetsj T TAL <br /> CASH RECD: CfiECI,(M. PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION ' <br /> NON4RCRA HAZARDOUS W TE,LIQUID(USED 04LIMIXED OILS)*NO PLACARDS REQUIRED" ' l3TATE CODE 221 <br /> NON-ACRA HAZARDOUS TE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)"NQ PLACARDS REQIOIR>rD• STATE CODE�. <br /> OTHER: `-�'J" <br /> DESIGNATED TSUF: "-'� <br /> ALTERNATE TSOF: - <br /> CFR:33210 Western Avenue, Union City,CA 94587(510)487-9277 <br /> DRUMS PIU: EMPTY DRUMS. FACILITY: BSC_ <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> -W�weals blow�IM1aby aartly that described,peekagW,mMkad tell willed,and Is M proper condition for van npoAetltm,�sacnrdlmg b applbable Iltala <br /> and"nkl 1`1101111111110"s,BY Sighing <br /> (Wage Wll generator/Customer MUST dxx*ONE of the following three boxes) <br /> 7)I hm not mitred my Of we wap dsecrlbed above with my other 111"41 11 werls,we teal 1'10140 content Is LEE!than 1,000 ppm,rand th{,well$dorsa not contain any PCgs.I hers <br /> o led With UK niquUIO,IP,Pa of Wt apoggN*tstlfarmla uwd all rI Mlapam enl regulations(a drtsrmnlne IN Ir true.I errs to accept the addlt{MAI charges far the dIsPOMI of this waste <br /> ■ <br /> an kdrmwen 1 he,n Provided IOWA dtis wasp la kmeorract <br /> 0 diI I have not tfllaed arty o1 tial mvMpe daMaibo above wIM My other haaaMous waste,the toll halide condom is GREATIM than 1,000 ppm,and tat writs dors nbt contain any PCEI.1 <br /> 1'm pro~1 Prapr doeurmwntatlan so Asbury Emironmemtal Ilervicas to rabid the Prseunrptlon drat own want wee mixed with amrr hazardous waste.1 jsWgn to rccap the&Mflanmi c"argr <br /> syr dors dmpnw ar ow k-sass a We kllorm w I have pro■Ided about this wash If krcorrrd <br /> p 031 This waste in ham a a*which collects was"all from household"Ae.lt.yaur"W(ice)andlar t anditlanelly MMP am&"quantity gsmrala 10E>lOGI sourer.To the bell of my <br /> knowledge,she,a"vnwM as contained M my WY1 CE&W coltecum tank Is coley Nam DIY crow CEECG v urcr.I have not hmlted this waste At with any other haurdous went*or <br /> waste all from olher eowom 1 NFw w m=W am iadlMbonad charges iw Aso""of dee wwatr ifwe Infumetlan 1 have pravldad about We weets rr Intern[! <br /> (All generators/cusbomem MUST read the following text and check the amodalmd box.) <br /> aa)M I m,s large gW tity gMaraw,I csrtly that 1 have■program in pleoe to reduce On rdums end toxicity of weals q"n stad to IN degree I have delerminad to be ecorMmfully <br /> rte the,I hm selaCw we Prsctlaablrl mewed aI tnalnrnt,stwepe,or dirpasw u+rremdy ralisble to Fr= nlma n <br /> l "pream MMd futon+thrM to human lift andM <br /> the Wffi orsmant;Or,11 I antlty gerptor,I hal MOO a goad faith~10 M1111M IP my wasn <br /> waste gendom and the benls nwinI/r^'ownielf method ave <br /> that Is llebls <br /> at I <br /> t 4 <br /> 71+1(LI L— ro� 0it <br /> Customer Siprt;l Dots Driver aignatu6t Date <br /> Print Name <br /> Print Driver,,Name <br />