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FC 7,SF_RV�_--E'C ALL: SERVICE ORDER <br /> DIXON OFFICE FSR%l NO AESON-B(REV 8/151 <br /> 1-800-7-ASBURY <br /> FRESNO s [SERVICE�ORDER NO- <br /> 559-498-0240 i <br /> CHiCO OFFICE <br /> 800-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON, CA 90221 <br /> P TRANSPORTF-P, EPA CA702B277036 <br /> F <br /> ........................ <br /> CUSTOMER# PURCH74!iiii�� ROUTE# TRUCK# <br /> MER R HA E t# 1_15N�O�A_ <br /> M <br /> OU-STO # PU C S 0' CT N <br /> N 1.15 TACT NAME ORDER 1AKEN BY HAI-IDES <br /> QUI <br /> DATE REQUIRED <br /> DATE NTE CUSTOMER <br /> M P <br /> DATE REQUIRED DATE ENTER—ED NEXT SERVICE D CUSTOMER EPA MANIFEST 4 <br /> PART# DESCRIPTION <br /> QT-y UNiT�PRICE Q_ PIU TOTAL <br /> CASH REC'D: CHECK# <br /> VVASTE DiSPGSAL INFORMA-1-ION <br /> NDNR RA <br /> NON-RCRA HAZARDOUS WAST;--, LIQUID(USED OILIMIXED OILS)-NO PLACARDS REQUIRED� STATE CODE 221 <br /> N N-RCRA HAZARDOUS 0 <br /> 0 OT <br /> NON-RCRA HAZARDOUS WASTE LIQUID(ETHYLENE GLYCOL SOLUTIONS"*NO PLACARDS REQUIRED� STATE CODE <br /> THER: <br /> D SI T <br /> DESIGNATED TSDF. <br /> fALTERNATE TSDF: <br /> DRUMS PIU: EMPTYDRUMS: FACILITY: 5SC <br /> GENERATOR WAA STE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to certify that the waste described a�vc is PrOPerlY cia-saified,described,packaged,rnarked and;sbeld,and is in proper condition for Iran sponphoii according to applicable Slate <br /> and federal regulations.By signing below I also hereby rertity.hat: <br /> (Waste oil generator/Customer MUST check ONE of the following three boxes) <br /> 4�#111 have not mixed any Of the waste described above Mth any other hazardous wasx6,7hz total halide ccrrtent is LESS than 1,000 ppm,and the waste does not contain any PCBs.I have <br /> complied with the requirement,,of the applicable Calif0fi,ja used pit managem, r regi ions Zs to determineihis Is agree to accept the additional charges for the disposal of this as <br /> . p t <br /> if the information 3 have provided about this waste is incorrect <br /> m w te <br /> L]#2)1 have not Mixed any of the waste aescrl,yed above with any other hazardous waste,Inc notal halide content is GRLATER than 1.000 ppm,and the waste does not contain any PCBs.i <br /> 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 <br /> for the disposal Of this waste if the information 1 have provided about this waste is incorrect <br /> 0 43)This waste is from a tank which collects waste oil from hcusehold (D!Y)andt roriditicn4llY exempt small quantity generator iCESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIV CESOG c0fleution tank is Soley from NY andfc�CESOG sources,f have n0l nixed this waste 014 with any other hazardous waste or <br /> waste oil from other sources I agree to accept the addilionw(:/larges for disposal ofthis wast"the"'fOpm8tiOn i have provided about this waste is incorrect <br /> (All generatOrs/CUStomers MUST read the following text and check the associated box.) <br /> 4#4) If k am a large quantity generator,J certify that 1 have a program in place to raduze the vcturne and t-0ty of waste generated io the degree�have determined to be economically <br /> practicable and that I have selected the it <br /> pract icable Method of lirewritent,storage,Or disposal currently available to me which minimizes the present and future threat to human life and <br /> the-environment;. Or,it I am a small Quantity generaloyr, IIRVO made a good faith effort to minimize my'waste generation and select the best wage management method that is available <br /> to me that I can afford I <br /> 2 <br /> C�fbmer�Signat�ure <br /> Date Driver e. i Date <br /> Print Name <br /> Print Drivbr-s-Wm`e <br />