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FOR SERVICE CALL: SERVICE DIXON OFFICE v G� �'1CID FORM NO.AESOdB(REV 1007) 1-800-7-ASBURY SERVICE ORDER NO. FRESNO 2 0 2013 559-498-0240 _ t ^^,r•r.," CHICO OFFICE -- IRONMENTAL 800-733-9043 H TJ-I DEPARTMENT ASBURY ENVIRONMENTAL ICE 1300 SOUTH SANTA FE,COMPTON,CA 90221 AF 1-310-886-3400 SAFETY KLEEf I v-iRn^RATE FRESt TRANSPORTER EPA#CAD028277 036 P 3301 11 r•IAVC�t4E RD 2�30)f I C E f ITR A!_EXPRESSkVAY -31- E D T ST.%—KT._f1 CAaefts RICHARDS•?tJ TX -5080 O 4209? 931 's'— 1664' IIA4-6257 CUSTOMER# PURCHASE ORDER# ROUTE# I TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES C3AF�tlQ teA � SAFETY KLEF!`.• kan erson DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# �( 12x5'2013 12/412013 GkG48 fi?1; C J ( 5 ( J PART# DESCRIPTION QTY UNITPRICE QTYP/U TOTAL ',Ah:? USED OIL I MIXED"ILS WOSG USED 04L SERVICE CHARGE SK,?A S Streets. TOTAL CASHREC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)*NO PLACARDS REQUIRED` STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED' STATE CODE_ OTHER: DESIGNATEDTSDF: m,,;twlf 4Y Stets A°�1'A 4474400 °"3491't'�f13 - ALTERNATE TSDF: SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 DRUMS PN: EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX 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 Slate and federal regulations.By signing below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) 4$p )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 P) 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 11 the information I have provided about this waste is incorrect D 012)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 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 the information 1 have provided about this waste is incorrect D#l)This waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)andlor conditionally exempt small quantity generator(CESOG)sources.To the best of my knowledge,Me only waste oil contained in my DIY/CESOG collection tank is soley from DIY and/or CESOG 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 the information 1 have provided about this waste is incorrect (All generators/customers MUST read the following text and check the associated box.) Vi 4) 111 am a large quantity generator,I certify that I have a progragi in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically acticable and that I have as Me practicable method of treatment,storage,or disposal currently available to me which minimizes the fir, and future threat to human life and t e environment;Or. III am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best wp to management method that is available to me that I can afford. / yo ti 13 Customer Signature/ M Date DriJBr mature Date -cc AN I Print Name Print Driv& ame.