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Jan 16 09 04: 50p OLYYMPIC TUNEUP 209_334 0180 P• Y <br /> is <br /> SERVICE ORDER FORM NO,AES004-BIR.EV 10107) <br /> FOs SERVICE CALL: <br /> DIXON OFFICE SERVICE ORDER NO. <br /> 1-800-7-ASBURY _ - ,- <br /> _ a <br /> UNION CIT'OFFICE — x <br /> 1-888-603-8844 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> s 1-310-886-3400 <br /> H TRANSPORTER.EPA#CAD028277036 <br /> r <br /> 0 <br /> ORDER TAKEN BY HALIDES <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME <br /> "' - MANIFEST# <br /> r <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# <br /> QTY UNIT PRICE QTY PIU TOTAL <br /> i PART# DESCRIPTION <br /> 1. t <br /> c - <br /> i .;; . .. . .- . € TOTAL-�- <br /> CASH RECD: CHECK# <br /> PLEASE P;'1Y FROMTHIci SERV! RDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)`NO PLACARDS REQUIRED` STATE CODE 221 <br /> NDN-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 /> IDRUNISPIU: <br /> _ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is to cadifv Thal the waste described above is property cl.ceiried.described,packaged.marYed and labeled,and is in proper condition for transportation,according m applicable State <br /> and federal ragvlalions.ay signing below I also hereby certify trial: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> of tent is 0 #.111 have not mixed any of the waste del applicable Oablitomul used oilmanagementrat ragvlalions to determine this Is vmEs gree to ac apt thS than 1.000 Plon,ea and it1ional charg s far me disposal of thise does not contain an,PCsiwaste <br /> have <br /> complied wilt,'he regviremants of the app i <br /> if the information I have provided about this waste is incorrect <br /> µZ)1 have not mixed any of warm described above with any other hazardous waste,the total halitle content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I <br /> hrwo provided proper documentation to Asbury Environmental Services to rebut the presumption the IM1is waste was mixed with ether M1azartleus waate.l agree to accept the adtlitienal charges <br /> for his disposal of this waste if the information 1 have provided about this waste is incorrect <br /> O H3)This waste is from a lank which collects waste oil from household"dolt-yourself"(Dly1 and/or conditionally exempt small quantity generator)CESQG)source.To the best of my <br /> kng3)This waste <br /> waste ail contained leI.my Qlyl CESQG collection tank is#clay from Dry andlor CESQG sources.I have net mixed this waste oil with any other hazardous waste w <br /> waste oil horn other sources.I agree to accept No additional charges for disposal of this waste if the Information I have provided about this waela is lncormct <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0 04)It I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity or waste garlanded to the.dag[oo I have dabom nad to be oconami <br /> practicable and dist I have selected the practicable meth„;of a made a hood faith effort tat storage.or eminlmim my waste gonarati n and selecillY..liable 1.me which t tlhe best wall-opener ompat method es the p,O.6.t and rmm.threat to that Is available <br /> It.environment;Oe if 1 am a small quantity generafoc 9 <br /> to ma that pomp afford.: r 'I <br /> Date - DriverSigctature Date <br /> Custbmer Signature � " - � , <br />