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FOR SERVICE CALL: • SERVICE ORDER • 1101` "FFICE FORM NO.AES0048(REV 101071 1-800-7-ASBURY _ SERVICE ORDER NO. _UNION CITY OFFICE � �_ 1,111 1.7"?.35'-1 1-888-603-8844 ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE,COMPTON,CA 90221 S 1-310-886-3400 H P 1'! fii; PlYlltlltt.E i'i't?il'r§t:f TRANSPORTER EPA#CAD028277036 E 3 I itir f tial t l L. #:{7 ,t �;',< t� 11(4f.�J.'I:' ROAD D J5 K" w':i;e:t7 � It RA C.�.. f 4� .5 flif� (.,. "11:^ ( ,20 k) k :3!-' x' rt?2Of CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# Fi% t .",1i { 6115/2030 :. . —y i 1 'r^t` c PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL f W:,L1RANC:i: F LIE L. SURC"HAR'G,E_' i i 1.7. 41!%1 10 t:Fi1.f. t9A1 61:"'Y' Mf^'.l Af.. 1)F't(1N 1 '.E ab4�, i S� It41�A.:'If0 }RIAKE Erf?AKt: i..ATHE i-iFlml fJ4f,' PER i7E"Uh I $2 2!J 00 +t,22`5i. Oil rit3AP i E:e-set s. HAZ W)S T E: Af:'C OL)NT __ TOTAL CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDERy WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED 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: IN SA RECYCL17: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 Q DRUMS PN: 1 EMPTY DRUMS: FACILITY �° � BSC �CCT � 8D GENERATOR WASTE �- CERTIFICATI PLEASE CHECK THE APPR( PRIATEE �E This is to cartify,that the waste described above is property classified,described,packaged,marked and labeled,and is in pre t and federal regulations.By signing below I also hereby certify that; (Waste oil generator/customer MUST check ONE of the following three boxes) 0 #1)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 complied with the requirements of the applicable California used oil management regulations to determine this Is true.I agree to accept the additional charges fonthe disposal of this waste it the Information 1 have provided about this waste is incorrect 0#2)1 have not mixed any of the waste described above with any other hazardous waste,Me total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.I 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 Me additional charges for Me disposal of this waste if Me information 1 have provided about this waste Is incorrect 0#0)This waste is from a tank which collects waste oil from household"do-it-youmetr')DIY)andlor conditionally exempt small quantity generator(CESCIG)sources.To the best of my knowledge,the only waste oil contained In my DIY/CESDG 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 Me Information 1 have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) 0#4) If I am a large quantity gonerator,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 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 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 to me that I can agord ° j„ _ 4' Customer Wnature Date Driver Signature Date Print Name Print Drivers Name