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_J FOR SERVICE CALL: SERVICE ORDER DD(ON OFFICE FORM NO, AES0041-B (REV 8/15) 1-800-7 ASBURY SERVICE ORDER NO. i FRESNO _ 559498-0240 ILit CHICO OFFICE 800-733-9043 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE, COMPTON , CA 90221 Hl iti, 886-3400 i1 . ; p TRANSPORTER EPA # CAD028277036 p - _ E D T _ ..� _ - It Vit! till CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES it � . DATE REQUIRED DATE ENTERED NEXT SERVICE: DATE CUSTOMER EPA # w . MANIFEST # - itlit I. .9.i' , µ ,�,' �' +� � ,> # _ kt,. .. PART # DESCRIPTION QTY UNIT P CE QTY P `' TOTAL it tit 1 , TOTAL CASHREC'D: CHECK # WASTE DISPOSAL INFORMATION NONACRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) *NO PLACARDS REQUIRED* STATE CODE 221 NON"RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) *NO PLACARDS REQUIRED* STATE CODE OTHER: DESIGNATED TSDF: it . , _ I � , . l ALTERNATE TSDF : I - I it , SA RECYCLING : - 23285 Ei'ch (er, 'St2. E;' lia}rward, G7a� 945dy 3 921 =4 84 � ' " iklel %I IIIIV DRUMS PN: EMPTY DRUMS : FACILITY BSC- GENERATOR SCGENERATOR WASTE ' CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to certify that the waste described above is property classified, described, 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 ail generator/customer MUST check ONE of the following three boxes) Il l)"Chave 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 complied with the requirements of the applicable California used oil management regulations to determine this Is true. I agree to accept the additional charges for the disposal of thiswaste if the information I have provided about this waste is incorrect ❑ #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. I 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 . 0 #3) This waste is from a tank which collects waste oil from household "do4t-yourself" (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my knowledge, the only waste oil contained in my DIY! CESQG collection tank is soley from DIY and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or waste oil 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 ' (All generators/customers MUST read the following text and check the associated box.) p i If I am a large quartity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to which minimizes the present and future threat to human life and the environment; Or, if I am asmall quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me that l can afford.