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ERVICE ORDER <br /> *RM N0 AE5004-6{REV 10107} <br /> SERVICE ORDER NO. <br /> IFFICE <br /> 344 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE, COMPTON, CA 90221 <br /> 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> tGE z <br /> IET <br /> RUNT <br /> :R# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> 40 . 00 <br /> 4C , 00 <br /> IIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> DESCRIPTION QTY UNIT PRICE QTY P1U TOTAL <br /> TOTAL <br /> 'D: CHECK# FLE-ASE PAY FROM THIS SERVI ICE OR,i ER <br /> WASTE DISPOSAL INFORMATION <br /> RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS)"NO PLACARDS REQUIRED" STATE CODE 221 <br /> RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED* STATE CODE <br /> R: <br /> 'NATED TSDF: <br /> RNATE TSDF: <br /> 33210 Western Avenue, Union City, CA 94587 (510)487-9277 <br /> J: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> y that the waste described above is property classified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State <br /> ulations.By signing below I also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> ,t mixed any of the waste dgscribed above with any other hazardous waste,the total halide content is LESS than 1,600 ppm,and the waste does not contain any PCBs.I have <br /> 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 /> on I have provided about this waste is incorrect <br /> d mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,090 ppm,and the waste does not contain any PCBs.I <br /> proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.t agree to accept the additional charges <br /> I of this waste if the information I have provided about this waste is incorrect <br /> to is from a tank which collects waste oil from household"do-it-yourself"¢DIY)andfor conditionally exempt small quantity generator{CESQG)sources.To the best of my <br /> t only waste oil contained in my DIY!CESQG collection tank is coley from MY andfor CESQG sources.I have not mixed this waste oil with any other hazardous waste or <br /> 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 /> (All generators/customers MUST read the following text and check the associated box.) <br /> 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 /> I 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 /> nt;4r,if I am a small quantity generator,t have made a good faith effort to minimize my waste generation and se$ect the best waste management method that is available <br /> i afford. <br /> Signature Date Driver Signature~ Date <br /> P Print Drivers Name <br />