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FOR SERVICE CALL: SERVICE ORDER - <br />�OIXONOFFICE FCRf.+t10 Atsccaa(17F/ to.o7) <br />1-800-7-ASBURY _—_ _ SERVICE ORDER NO. <br />UNION CITY Qr,F- CE _ n <br />1-888-603 8844 <br />CHICO OFFICE <br />800-733-9043 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />S 1-310-886-3,100 <br />N COOKS CAU-i510N L _ <br />I TRANSPORTER EPA # CAD02827703629�0.,AUTQTU -19 <br />T; (�� 11'il ATI:- CLI <br />E <br />` Ti AC CA `1304 <br />C209� <br />CUSTOMER # <br />PURCHASE ORDER # ROUTE # <br />TRUCK # <br />CONTACT NAME <br />ORDER TAKEN BY <br />HALIDES <br />COOfcfL2- <br />DATE REQUIRED <br />DATE ENTERED NEXT SERVICE DATE <br />CUSTOMER EPA # <br />MANIFEST # <br />11317013 <br />1 112 ZOG <br />C.ALcloc qE?7(aD <br />PART It DESCRIPTION QTY <br />UNIT PRICE <br />QTY PIU <br />TOTAL <br />3o (yTM W CAM-LCN cV—j META— i* UW 1 <br />TOTAL <br />CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) 'NO PLACARDS REQUIRED' STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) 'NO PLACARDS REQUIRED' STATE CODE <br />OTHER: <br />DESIGNATED TSDF: — <br />ALTERNATE TSDF: <br />SA RECYCLING: 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br />DRUMS PN: EMPTY DRUMS: FACILITY: BSC <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />This is to certify that the waste described above is property classified, described, packaged, markod and labeled, and is in proper condition for transportation, according to applicable Slate <br />and federal regulations. By signing below I also hereby certify that: <br />(Waste oil generator/c(.tstorr(er MUST check ONE of the following three boxes) <br />❑ #1+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 <br />c0mpllad with the requirements of the applicable California used oil management regulations to determine this Is true. I agrao to accept the additional charges for Ilia disposal of this waste <br />if the Informallon I have provided about this waste Is Incorrect <br />❑ 02) 1 have not mixed any of Ilse waste described above with any other hazardous waste, the total haildo content Is GREATER than 1,000 ppm, and the waste dces not contain any PCBs. I <br />have provided proper documentation to Asbury Environmental Services to .but the presumption that this waste was mixed with other hazardous waste. t agree to accept the additional charges <br />for the disposal of this waste if ilia information I have provided about this waste is incorrect <br />0 #31 This waste is from a lank which collects waste oil from household'do-it-yourself• (01YI andlor conditionally exempt small quantity generator (CESCG) sources, To the hest of my <br />knowledge" the only waste oil contained in my OIYI CESOG collection lank is soley from DIY andlor CESCG sources. I have not mixed this waste oil with any other hazardous waste or <br />waste oil from other sources. I agree to accept the additional charges for disposal of this waste it the information I have provided about this waste is incorrect <br />(All generatoi:s/customers MUST read the following text and check the associated box.) <br />0 #4( If 1 am a large quantity generator, I 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 <br />practicable and that I have selected the practic2bla method of treatment, storage, or disposal currently availatle to me which minimizes the present and future threat to human life and <br />the environment; Or, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available <br />to me that I can afford. ". <br />Customer Signature <br />Print Name <br />Data Driver Signature Date <br />Print Drivers Name <br />