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EOR SERVICE CALL: SERVICE ORDER FORM N0.AE5004•8 1REV 8/15} DIXON OFFICE 1-800-7 ASBURY �� SE W9E,ORDER'N0,., w FRESNO 559-498-0240 WOW, U22BSM_ CHICO OFFICE AF 400 800-M-9043 ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA.FE,COMPTON,CA 80221 " TEG OF CALIFORNIA 1-310-886-3400 LOUISE AVE TRANSPORTER EPA#CAD028277036 P 2050 E 2050 E LOUISE AVE o t T LATHROP,CA,95330 LATHROR CA 953$0. ° �Z09y.858M41'10' ( 9}am.4110. GUST 1G[ER: t`F A49ORD-, V.. 'ROUTE#;� TRU #"i - CO ACT Ew _ ORDER'TAKE -BY NA.tQ ` i� •i.�'„. rTL=R RbAfiE ERRED _ NEXTSERVICDA CUTMER:EPA#2=10 12=10 1 :PAR.�#_. b..SSC IPTION Ty PRICE"1 ATTIZE _11-TA.; ... ........�..__..__._...._...._._...... _.... ..._ t1'_ - 1 t R 1 Z C -DR.- fOLFILTER DRUM RERLACCMENT-NO CHARGE- v,00. (. o oo :OP USED METAL OIL�lND�GA90UNE FILTERS D'~ 55.00 y 33000 F CELL 2M.0 M12-8 of 0 BATCH#,__,_,_____ ......._ ....... .. TOTAL • H '.d CHECK# � WASTE DISPOSAL INFORMATION N PA-HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)"NO PLACARDS REQUIRED* STATE CODE 221 NON•RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED# STATE CODE OTHER:. DES1Q �.... -, f. ALTERNATE TSD F:.YUMA;YE$.U:C.7JOE.tfM B'1r .YM1 ,83 - . ,. DRUMS.P/U: EMPTY DRUMS: FACILITY: ft�B$C„_____;: GENERATOR-WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to certify that the waste described above is property claseifiod,doscribed,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) D 01)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,and the waste does not contain any PCBs.I have compiled with the requirements of the applicable California used all management regulations 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 was is is Incorrect p#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.l 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#3)This waste is from a tank which collects waste oil from household"do-it-yourself'py)and/or conditionally exempt small quantity generator ICESGG)sources.To the best of my knowledge,the only waste all contained in my 01Y/CESQG collection tank Is soley from DIY and/or CES06 sources.l have not mixed this waste all with any other hazardous waste or waste all from other sources.I agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste Is Incorrect (Alt 9e i0_mtors/Wstotners MUST read-the.followitng texand check the:assoclateti box.) !Nf(!►a bl+trg�gl►srttily`genstatdf,t 0h.W that 111sVa. progtarti in place to rw"*.thi volume and toxidlr of woof*generated to the depreo.l have.datomstnsd to be.economically � fl►bts.;ind thal.l have silectod the practicable molhod of treatitiont�dtaragp,a dlsposat gttirenity:s+tsiisbfa to clic vvh)cit►rrirtit111ias the prop Wttuo throaGto:hurns#t'Iife.ailit flee ggWroAinehtt'8r,ll ant a irr�tl gvultlly'pohorator;.l fiave:msde.s'.gpod taltlti atloit1oYrtiiiiinlze retjr.w�ala.ganorstlon�nd:.salocf the Mtpi t1s' n+gameal mathod,ehai Is avajlabls to me that I." sto. r1 re Date Driver nature Date r Print Name I Print Drivers Name