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DIXON OFFICE . 10 ---. <br /> 1-800.7-ASBURY - ___— SERVICE ORDER NO. <br /> UNION CITY OFFICE _ _ <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> s 1300 SOUTH SANTA FE,COMPTON. CA 90221 <br /> H 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> L <br /> r <br /> CUSTOMER# PURCHASE ORDER# IROUTE# j TRUCK# I CONTACT NAME I ORDER TAKEN BY HALIDES <br /> DATE REQUIRED1 DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU I TOTAL <br /> TOTAL <br /> CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXEO 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 /> CFR: 33210 Western Avenue, Union City, CA 94587(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 properly classified.described,packaged,marked and labeled,and is in proper condition for Transportation,according to applicable State <br /> and federal regulations.By signing below I also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 'Q 01)1 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 /> complied with the requirements of the applicable California used oil management regulations to determine this Is true.l agree to accept the additional charges for Me disposal of this waste <br /> if the Information I have provided about this waste Is incorrect <br /> C#211 have not mixed any of the waste describes 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 <br /> 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 <br /> for the disposal of this waste if the information 1 have provided about this waste Is Incorrect <br /> a#3)This waste is from a tank which collects waste oil from household"do-it,iturself"(DIY)and/or conditionally exempt small quantity gener0er(CESpc)sources.Te the bot of my <br /> 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 o0 with any oMer hazardous waste or <br /> 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 <br /> (AAI generators/customers MUST read the following text and check the associated box.) <br /> ` #al If I 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 /> p acticable and that I have selected Me practicable method of treatment,storage,or disposal currently available 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 Date Driver Signature Date <br /> Print Name Print Drivers Name <br />