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FOR SERVICE CALL: / . SERVICE ORDER <br /> DIXON OFFICE • FORM NO.AESgBLBTEV igW) <br /> 1-800-7-ASBURY — _ _ _ SERVICE ORDER NO. <br /> _= N9-1 44Sti r' <br /> UNION CITY OFFICE �_ _ <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> B 1-310-886-3400 <br /> S <br /> a OLYMPIC TUNE TRANSPORTER EPA#CAD028277036 <br /> E 40QI NORTH CLUFF AVF 400 NORTH CLLIFF AVE <br /> D <br /> TLODi, CA 95240 <br /> LODI„ CA 95240 <br /> O <br /> (209) J34-0617 t209) 334-0617 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> OLY018 95 1 GENE: Likkeiia <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> I 26/'20".. 11/25/24" CAL(60030481.3 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU I TOTAL <br /> }} E+3E:R OlL € ND UCiSC1L.LNE F ELTE i s5h. Oki <br /> HE' ASKED FOR A P/U TOMORROW IF POSSIBLE. <br /> C1" ,>' 1:i C3Eitl3 <br /> TOTAL •fG. <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED 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: t 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,marked and labeled,and is in proper condition for transportation,according to applicable Stale <br /> and federal regulations.By signing below I also hereby codify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> D 41)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.I agree to accept the additional charges for the disposal of this waste <br /> if the Information I have provided about this waste is incorrect <br /> D 42)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 net contain any PCBs.I <br /> be"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 I have provided about this waste is incorrect <br /> D#3)This waste is from a tank which collects waste oil from household"do-ILyoureelr(DIY)anclor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection lank is soley from DIV and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other emouse-I agree to accept Ne additional charges for disposal of this waste if the Information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> O##I 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 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 has"t ieaflord _ <br /> } <br /> Cusjjtbmer Signature , Data �_ Dgyer-SlgaaturlB Date <br /> i(t/7;ij X tl}if ;dt <br />