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Lr I/C� FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE FORM N0.AES004-8(REV W) 1-800-7RY _ SERVICE ORDER NO. UNION CITY OFFICE i = N918,786 °88-603-8844 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE,COMPTON,CA 96221 H 1-310-886-3400 P HIER...•T OF CALIFORNIA -- WEST -,'MMSPORTER EPA#CAD028277036 EP ' ,3FI.r'.'>'iJ CHfkNNIL k)I•::l.VL.` PO BOX X D +Ik �7 `F;Aa4IrNT1), CA 95.691 SACRAMENTO„ CA 5t 81,11.3 (916) 3 7 3-4 1 St-5 (926) 373--4155 CUSTOMER# PURCHASE ORER# ROUTES TRUCK# CONTACT NAME ORDER TAKEN BY HAUDES Ht1Lrd�'F3 '. U MARTIN wriorse DATE REQUI DATE ENTE D NEXTSERVICE DATE CUSTOMER EPA# MANIFEST# 7/8/20081 7/7/200 f"AL000827893 PART# DESCRIPTION_ QTY UNIT PRICE QTY PIU TOTAL' OF .IJSE D OIL. AND .GA�iCIL.INE F�'IL.TERS 13, . �0.00 ,00 Is .0 1; oaf ..Drt-.ms, Needs Service ASAP. C:i-r)ss s tt ofiss TOTAL ` 5HREC'D: CHECK# ` PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)"NO PLACARDS REQUIRED* STATE CODE 221 NON RCRA HAZARDOUS WASTE LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED" STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF:' i CFR:33210 Western Avenue,Uj•ion City,CA 94587(510)487-9277.- j DRUMS P1U: EMPTY UMS: . FACWTY.:, BSC ;M GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX This is to certify that the waste described above is pro arty classified dascrlbad pit kagad,marked and labeled,and is in proper condition for transportation,according to applicable State and federal regulations.By signing below I also hereb certify that: (Waste oil nerator/customer.MUST chedc ONE of the following three boxes) 0#t)I have not mixed any o1 the waste described abs ow{thany other hazardous waste,the total halide content isLESS than-1,000 ppm,and the.wastedosa not contain any-PCBs have., complied with the requirements of the applicable California used di management regulations to determine this Is true.l agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is i'correct - 0 0112)1 have not mixed any of the waste described a e with any other hazardous waste,11ve total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.1 have provided proper documentation to Asbury Envir ental Services to rebut the presumption that this waste was mixed with other hazardous waste.l agree to accept the additional charges for the disposal of this waste it the tnformapon i have vided about lhi}walls is Incorrect - 0#3)This waste is from a tank which collects waste oil from household-do•R-yourssir{DIY)and/or conditionally exempt small quantity generator ICES gG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CE t]G collection tank Is Soley from DIY andlor CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the addlt'onal charges for disposal of this waste H the Information I have provided about this waste is Incorrect (All generators/cstomers MUST read the following text and check the associated box.) r 0#4) If I am a large quantity generator,I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically t ieticable and that I have selected the practicable met od of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and Penvironntent;Or,if I am a small quantity generator, have made a good faith effort to minimize my waste generation and select the best waste management method that Is available t:dime that I canafford. - e2e Customer ignature Date Driver Signature Date. Print Name Print Drivers Name