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FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-7-ASBURY <br />UNION CITY OFFICE <br />SERVICE ORDER <br />tltmtr f� a — <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA * CAD028277036 <br />FORM W) AEW4.2 {REV iMM <br />SERVICE ORDER NO. <br />I'19639-119 <br />1471 illicipf, S r <br />CUSTOMERS <br />' PURCHASEOROMS <br />TRUCK # <br />CONTACT NAME <br />ORDER TAKEN 8Y HALIDES <br />t910>VrE1#j1 <br />DA N RE <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA # <br />MANIFEST # <br />0 *::`s?. 200 <br />?►,3r: I +a+voFif <br />r:ril,4#i}44Z!li /li k .� <br />r <br />PART <br />DESCREPTION <br />QTY <br />UNIT PRICE <br />QTY PJU <br />TOTAL <br />tial.Y l" -i71 it I1J! ttilJ. LUN <br />TOTAL <br />`,cis aFr_n• claFt^K P! FASF PAY FROM THIS <br />SERVICE <br />ORDER <br />— - -- WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILJMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 <br />NON-RCRA HAZARDOUS WASTE, UQUID (ETHYLENE GLYCOL SOLUTIONS) 'NO PLAdARDS REQUIRED' STATE C0011.2Z3 <br />OTHER- <br />DESIGNATED <br />THER DESIGNATED TSDF- <br />ALTERNATETSDF- RA110b c• F, - 't 'i .U.•. 611,6) P 'r "!; 41fiftA .: <br />CFR: 33210 Western Avenue, Union City, CA 94587 (510) 487.9277 <br />DRUMS PIU- EMPTY DR MS' - FACILITY: 051,'- <br />GENERATOR <br />51,' <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />This is to certify feat the wadi desuibed above Is properly eNsstfisd, described, packaged, marked and labeled, and Is In proper condition for transportation, accardtrtg to appilrAbte Stats <br />and tede-1 regulations. By signing beta- I also herby cartify that: <br />/.II <br />(Waste oil generator/customer MUST check ONE of the following three boxes) <br />I have not mlsed any of the waste described above with any 04tw hazardous waste, 8vs total halide content fe LESS titan 1,000 ppm, and the waste does not onntatn any PC8s- I have <br />plied with the requirsrneins of the apptlCabis Catlfomia used oil itunagement rogwations to delarmfns ads Is true. I mares to accept the additional charges for the disposal of this waste <br />if the Infopnatfon I have provided about this wait* Is incorrect <br />❑ 02) 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 captain any PCBs. I <br />have provided proper documentation to Asbury t'rivtronmenul 6ervkes to rebut the presumption Chet this waste was mixed with other hazardous cresta. I agree to accept the additional chuges <br />for the disposal of this waste It the Information I have provided about this waste Is Incorrect <br />0 s,31 This waste is from • unit which collects waste dl from household "do-it-yoursetr (hfYj andlor conaitlonatly exempt atrial( quantity ganarator fCESOG) sources. To the best tit my <br />knowledge, the only waste all contained In my RIY1 CESOG collection tank Is salty from MY andtor CESOG sources. I have not mixed this waste oil with any other hazardous waste or <br />waste ori from other sources. I agree to accept the additional charges for disposal of this waste If the iMotmmtion I have provided about this waste Is Incorrect <br />(All generators/ customers MUST read the following tent and check the associated box.) <br />�aW � am a large quantity ganerafor, I certHy that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have de4ormAnod to be economically <br />, .a and that( have selected the praeticabis method of treatment, storage, or deposal currently avalletris to me which minimizes the present and fulum Infest to human life and <br />'in,.nonment; Or, If I am a small quantity generator, I have made a good faith effort to mtnimiaa my waste generation and select the beat welts, management method that Is AvaNap(s <br />,to that 1 can afford. <br />Customer Signature Date Driver Signatu`r"ef Date <br />