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FOR SERVICE CALL ~� SERVICE ORDER Nee..", <br /> DIXON OFFICE <br /> 1-800-7-ASBUR✓ SERVICE ORDER NO. <br /> UNION CITY OFFICE ' <br /> 1-888-6038844 = r <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE. COMPTON. CA 9022' <br /> s 1-310-888-3400 <br /> a MAX I:M I:kANei_ WOFiK TRANSPORTER EPA#CAD028277036 MAXTM CRANE. III <br /> 2373 MARIPOSA ROAD PO PDX 999 <br /> D <br /> o STOCKTON. CA 95205 LA PORTS. TX 77572 <br /> (209) 464- 635 <br /> CUSTOMER# PURCHASE ORDER# ROUTE#I TRUCK#j CONTACT NAME ORDER TAKEN BY HALIDES <br /> MAX602 MUST GET. 96 1 1 CIA IF.I..Y Ifco=.ti.o <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> 0/25/200'.. 8/24/2009 CAD98235694:i. <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> N/R L NON-RCRA LIQUID PER DRUM 3 <br /> IFS INSURANCE. FUEL. SURCHARGE 1. <br /> N/R S NON-RCRA SOLID PFR DRUM 6 <br /> 6 DRUIS OF SOLIDS - 2 55G LIC41JID TAR - 1. 30G LIOUID 1' t:: -- NO EPLAL' EN'T'S <br /> CTss Streets: I <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER I <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> NON-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 /> DRUMS Pi EMPTY DRUMS: FACILITY: BSC 1 <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> This is la camby that Me waale deacnbed above is popany claaairred,described,pacsaged.ma4ed and bbrdf.g and is in Wvoar condition lir tom.,onanon,accominq m appncaele$1.11 <br /> and federal regulations.By signing below I also hereby candy that <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 0 NII hay.not ne.Im any el the..is de enbed above with any abler luard...waste,in.mlal halide,omen,is LESS than 1 000 ppm.and ILe waste doe.not contain any PCBs.1 have <br /> vm'imor—In cle requirement.a the applicable California u..d vol management mqushom.m determine this Is tare.1 agree..accept the additional charges for the disposal of this waste <br /> if the Mfornauon I have provided about this waste is Incorrect <br /> 0 1311 neve not mixed any it tfa waste described above with any.Mer nanutotal <br /> rdis waste.tiro halide content is GREATER than I,D00 spin,and the waste does not contain any PCBs I <br /> h...Mmoded pope,documenfanm..Asbury Environmental Servicaa to rebut Me Mesomptivn that this waste was mixed with other hAtardous waste.I agree to accept Me additional charges <br /> For this disposal of finis wase It the information I have provided about this waste 1a incorrect <br /> 3 131 This*sate is bom a think which<dlKts waste oil from hou nue d'do.it.younelr'(Div)and/or Co nd,r.nahy.asm,.mall puanlM generamr ICESQIiI sources.To the.11 of my <br /> I nowledge,Me amy waste oB continued in my DIri CESW collection laud;Is%Way from DIV andmr Ci source.I have not mixed Mie waste oil with any other hazardous was or <br /> waela oil from WMr aourcas. agree to ecupl Ms WGlianal chargee Ivr dleposal of Mia wols 1l Me Infwmalion 1 M1ave provided eeeut Mie*alta b incwrKt <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0"1 filarialarge quannry genera....I certify treat 1 Nye a program In place to reduce the volume and toxicity of waste generated to the Madre.I have determined to be th,imm¢ety <br /> ,eve,sWe and that l have..heeled Me practicable method of usaimuit,.tvnge,of disposal cunsnuy evadable to me which mini ou.. be prneent and for.threan m human tete and <br /> 1N m <br /> Idoodd ent',0r it l am a..N qusiony pense ,n. I have made a good feignelfon Io minimise my wast.pon...firm and ebort lect Ina bowaste management method INl I.avula0le <br /> le ma Mal 1 can sewn. <br /> _I—r Customer Signature Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />