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Dec-03-0A 13:37 From-DI Dixon 17076782339 T-445 P.0041009 F-886 <br /> SERVICE ORDER <br /> FOR 3E CALL: FORM NO.AESooae(REV 10107) <br /> Oftm F IC5 , + SERVICE ORDER NO. <br /> 1-800-7-ASBURY <br /> 3 <br /> UNION CITY OFFICE J'746 <br /> 1-868-803-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON, CA 90221 <br /> S 1-310-686-3400 <br /> W TRANSPORTER EPA#CA0028277036 ,Fl F'E:�'ti' t:L F:Ei.M C O R f O R A Y F <br /> ti4 I.1:�:LACY DI:YVI-: <br /> e 1.40 3 C:l11.tI�IThY tt,_U1+ <br /> ° F'I._t NO. TX -x5024 <br /> T cj!)L;It r0N, CA 952041 <br /> 1:209) Y4,13--0749 ORDERTAICEN BY HALIDES <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME y <br /> 1.27 S5 GCIiEF,t,iL D o0j <br /> t3 E)Tt b 4 MANIFEST# <br /> PATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# 771-)e <br /> IiT}Nl32:i`i7'7 17 <br /> PART# DESCRIPTION QTY UNIT'p E QTY PIU TOTAL <br /> idl[19 . usi7D olL: SERVICE CHARGE � <br /> W() USED 1911_ / MIXED OII. $ t r <br /> CvclTiila TOTAL <br /> CASH REC'D:�- CHEC # PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> ARDS REQUIREW STATE CODE NON-RCRA HAAZARDOUS WASTE,LIQUIID(ETHYDLEN`GILYCOL SOXED ILUTTIIONSC NO PLACARDS RECIUIRED" STATE CODE <br /> lli <br /> NON-RC <br /> RA <br /> t. Y XON C 956' 7 7 93� CAl <br /> DESIGNATED TSDF: <br /> ALTERNATE TSOF: �— <br /> CFR: 33210 Western Avenue', Union City,CA 94587(510)487-9277' <br /> DRUMS PN:_ _- EMPTY DRUMS:_ FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This Is to canify that the waste 0041-01160 alfove is properly classified,described,packaged,marked and labeled,and in In proper conmtlon far tet nsl>ortatior;,according to appikeble 61411. <br /> and h0anl regula]lons,By signing bolo-t afso tier■h y cefllfy that: <br /> (Waste mil generator/customer MUST check ONE of the following three boxes) <br /> 41)1 have not mixed any of the waste described above with'any other har.41rdOus waste,the total halide content Is LESS than 1,000 ppm,and the waste coos not contain anyC s.I have <br /> le <br /> complied with the requirements of the appllcablai Callfornin used oil management regulation-to determine this le true.I agree to accept the additional-homes for the disposal <br /> If the information I have provided about this waste is Incorrect <br /> p 412)1 cava not Itlxed any of the-sate described above with any other 111i waste,the total halld■content is GREATER than 1,000 ppm,and the wool.Dao•not contain any PGB. 1 <br /> have provided ropers wast N tationlormetianryl Environmened Spout Services <br /> t rebut <br /> alto i■f's P's"'A pilon that this wale was mixed with other hazardous waste.I 1GTv to accept the Additional charges <br /> for the dlep <br /> p e7)Thin-sate is from a tank which collects wast■all from household"dolt-younelr tom and/ae conditionally exempt small quantity genorawr(CESOGI sources,To Iris beat of my <br /> Knowledge,the only WAVE oil contained In my 01Y/CE60G collection tank Is Way from DIY 41ntllar CESQG sources.1 haw not mixed this waste oil with any other haxar0ous wasle,or <br /> waste all from other■ourea■-I agree to accept the additional charges for disposal of this waste If the Inrovmatlon 1 have provided about thin-sato In Incorrect / <br /> (All generators/customers MUST read the following text and check the assodlated box.) <br /> of�aa)III am■urge quantity ganerstor;l asrdry that I haus a program In Place to rlurne And toxicity <br /> ordis disposal uce the ole artily available tom wa <br /> ste <br /> a the prevail and futy a three,eat to human life and <br /> nad to be ly <br /> practicable and that I have selected the praoticehFtmethod of treatment.storage, P -este pen■ntiona■t wasto m■n•gon'ont method that is availaui■ <br /> the etvlronmen, Or,"I am a small quantity pen r41tori I have mad.■goad t■hh effort to mlai mlie my to me that I can afford. r � ! l J 7,�9 <br /> �. Date <br /> Date <br /> Orivt?r Signature <br /> Customer Signature ! <br /> Print nriver9 Name <br />