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FOR SERVICE GALL: SERVICE ORDER <br /> DIXON OFFICE ASBUR'Y ENVIRONMENTAL SERVICES, ELBA FORM NO.VVOES004-8 (1/17) <br /> 1-800-7-ASBURY SERVICE ORDER NO, <br /> FOR:ACCOUNTING CALL: <br /> 562-231-1550 <br /> - `ENVIRONNiEN T AL SERVICES.: <br /> s <br /> H 7300 CHEVRON``IAY,DiXON CA 95620 <br /> 3-800-7-AS BI I R Y <br /> E VVV0VA&10RLDOILCORP.CO of <br /> J <br /> T TRANSPORTER EPA P CAD028277036 <br /> a , <br /> CUSTOMER PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA r BILL of LADING- ANIFEST# <br /> PART# DESCRIPTIONQTY UNIT PRICE L2TY PCU TOTAL <br /> i <br /> I <br /> E <br /> 1 <br /> TOTAL I <br /> CASH RECD: CHECK# i <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUiD(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATEDTSDF: <br /> ALTERNATE TSDE: <br /> 4 <br /> DRUMS P/U: EMPTY DRUMS:— FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) <br /> By 5igniny below I hereby certify haC <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> E!61)!have net mixed any of the waste described above with any other hazardous!vaste,she total halide cane is'LESS than 1,000 epm..and the waste tees not contain anv PCBs.I have Compiled with the requirements Of <br /> the applicable California used oil management regulations to determine this is true.I agree to accept the acidiVonai charges for the disposal of this waste if the information I have provided about this waste is incorrect <br /> 11 have not mixed any of the waste described above w' r h <br /> :th any otheazardous waste,the to till baud-content is.GREATER that)t,flUQ ppm,and the waste does not contain any Kits,I <br /> have provided proper documentation to World&Environmental Services io rebut the presumption that this waste was nvxed with other hazardous waste.l agree M,accept the additional charges for the disposal of this <br /> waste if the information I have provided about this wa5te Is incorrect <br /> E=1#3)This waste is from a tank which Collects waste oil from your$elf"VY)niWor conditionally eyemps small qu3amity generator ICE50G}sou=ces.To the best of my knoviledge,the only waste ell contained <br /> in my DIY?CESQG collection lank is coley from DfY F-ri CESQG.sources,I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept theadditionalcharges for disposal <br /> of this waste if the informarion I have provided about this-waste is Incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> .: 1W If l am a large quantity generator,l certify that I have a program in place to reduce the vol Lima and toxicity of waste Generated to the degree I have determfned to be economicatiy practicable and that I have <br /> selected the practicable method of treatment,storage,cr dlspasai currently av;iilable to me which minimizes the present and furore threat to human fife and the environment;Or,if I am a smal{quantity generator,l <br /> have made a good faith effort to minimize my waste generation and select the oEst waste management method that is available to me that I can afford_ <br /> This individual signing in the,pace set forth bele-x pr,behalf of Customer represents and warrarrrs that heishe has the autP+ority to bind Customar,that the forgoing descriptions Of waste and materials are true and accurate <br /> as packaged,marked and labeled,are ready for transportation in accardanre r11th applicable state acid federal regulations,and rhat Customer shall abice anua be bound by the Standard Terms and Conditions on the reverse <br /> side of this Service Order �q <br /> Customer Signature Date Driver Signature ` Bate <br /> Print Name Print Drk'vers Narrate ' mm <br />