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(/X5/C117 FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE FORM NO.AES004-B,(REV 10107) 9-800-7-ASBURY SERVICE ORDER NO. UNION CITY OFFICE r ,{ .I 777 R88-603-8844 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE,COMPTON, CA 90221 H t 1t:!1... I 1+1= I;t"i i._J.t +,?F+.hl:l:E lJ►::' t t`)i. i;. 1-310-886-3400 .. .E?€t x:�;(:: TRANSPORTER EPA#CAD028277036 P E D T t41, `:>T ;:i}it..FtAit ;f'i•1"l.f., tr•) 9"116lj:1. ;:;�Zi:Ftf"1F'�f:.('i)..f•l� 1":'•� ..#�i'i.,i { CUSTOMER# PURCHASE OR ER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTER D NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# 1.9 ' )x1.':_'01 9 !::' `I 0 0 h>;7 fJ9 PART# DESCRIPTION. QTY UNIT PRICE QTY PIU TOTAL .SE' l.. `.;;::x? L1.Lt� h!h +� .r=;;:)t.1?...lf�f C:. 3.f_ f k:.i'.... .''f b{,•;. {�r�a ,+'�, �t•.. 4,1' s,11�► 'I i:;.d P l P {'I t)!,'1`, ::) -10'P 4 F I')1 i l`:t...l F, ! TOTAL ,ASHREC'D: CHECK#1 PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WAST ,LIQUID(USED OIUMIXED OILS)'NO PLACARDS REQUIRED" STATE CODE 221 NON-RCRA HAZARDOUS WAST LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: SA RECYCLING: 2035 E. 15TH Stret,Los Angeles,CA 90021 1 (800)645-3458 DRUMS PN: EMPTY D .UMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to certify that the waste described above is pro p�rly 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 ertify that: (Waste oil generator/customer MUST check ONE of the following three boxes) ❑ #1)1 have not mixed any of the waste described abo a wlth 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 codetermine this Is true.I agree(OaCCept the Iadditional charges for the disposal of this waste if the Information I have provided about this waste Is Incorrect D#211 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 Environon tai 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 pr vided about this waste is incorrect ❑#3)This waste is from a tank which collects waste oft rom household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oil contained In my DIYI CESPG 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.) ❑ 94) If 1 am a large quantity generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically 'icable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and \ .ivironment;Or,if I am a small quantity generator,Piave made a good faith effort to minimize my waste generation and select the best waste management method that is available , me that I can afford. Customer Signature Date briver'Signature Date Print Name Print Drivers Name