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SERVICE ORDER �. . FOR SERVICE CALL: FORM NO.AitSO44a(REV 10,0-1) q DIXON OFFICE L ! -7-ASBURY v _� SERVICE ORDER NO. UNION CITY OFFICE - 1-868-603-884/ ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE,COMPTON,CA 90221 .s.,. _. .. 1-310.886-3400 v M 'iXIT•f, C`JiANf: .4JI f{1i:3 TRANSPORTER EPA 9 CAD028277036 �A�AeXT'M CR'(i14E'b?ORt13 E ?':i'7.3 Y'i41F21`Pli¢iR -i'i[i1'1J) PO BOX 1?99 D o' E "11 1I<'FtiYJ" f A 9'i^ii4 I-A POFl:1 T'X 77.,'.7'? J { r) 46476:35 (2QJ ) 471 17641 : . -CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# NTACT NAME ORDER TAKEN BY HALIDES NAXti4>02.. l;iJ;y"( „C: t .T ..,_. PER RYAN DATE REQUIRED DATEENTERED NET BERVICEDATE CUSTOMEREPA# MANIFEST# PART#M DESCRIPTIONQTY : UNIT PRICE QTY PIU I TOTAL fFS It4SUf fAPlQ t 11 .L. :3UFkLl{/yf't E % J,,h Oi `�5 U0. a of kJr ' 'ZF)yh DtkLRFA, <R'r-CI:Itilli 1 :'tJNiI::F I ;� C)I! Y QCiY SUL,TD PFAR DF2LJM F! r G I _ TOTAL - cases RECD: .HECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION." NON-RCRA HAZARDOUS VIA,STE,LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED" STATE CODE_ OTHER: {(r•'i, DESIGNATED TSDF: ALTERNATE TSDF: CFR: 33210 western Avenue, Union City, CA 94587(510),487-9277 DRUMS PN: -r ,EMPTY DRUMS: FACWTY: BSC GENERATOR WASTE CERTIFICATION PLEASECHECKTHE APPROPRIATE BOX - r,s is te csrMy that Ute wales described above Is propedy.lasa ified,desedbed,package0.-marked and labeled;and is inproper cored bon for transiamunion,according t.appl cable Star- and fedora regulations.9y signing below l also hereby c mny that + (Waste oil generator/..))tomer MUST check ONE of the following.three boxes) 0#111 have not mixed any of the waste des.Ib tl b with any other hbtardoui waste.he total hallds contents LESS than t,00o Ppm am the waste ages not contain any PCBs.l have ' compiled with the yaquirsmenla of the appllo tele Cal forma head oil managemma,.,.latlons to deurmina Mi.la true-lagree to accept tha,ddi[ional.remiss for th-tlsposal of this waste If the information l have provided about this waste is incorrect {% 0#2)1 have not mixed my of the waste dexdbed above with any other hazardous waste,the Wal halide..relent ie GREATER than hoz ppmradd IM waste does not conte n any -1 rh` have provided proper docummlahon to Ai Wry Environmental Services to rabbi the pr-sumption Nat this waele was nixed with other M1axard-us waste.lsore-to accept Me additional chargrs far the disposal of Mie waste If the information 1 have provido0 about this wateJa incortect O pd)Thls waste la from a tank which collects weals oil hem household"dolt-yourself(DIY)andror condifimally eaempr.mall quenuty genermor.ICESGG)...Ices,To On neat of my knowledge,M-only wants oil contalm l in my DIV/CESGG collection tank h sOley hem DIY mdlor CESGG souroae.l have not mixed this waste oil with any.Mar M1arardoua waste or walla OIIIIOm OMM aOVrteF l Ggree b eG<ePt Mi dddhlOnal CMfg9elnrdispOGaI Of MIG WNte g Me infCrmaliOn l haVa provided abOVf MiG Waele le ln.erreCt (All generators/customers MUST read the following text and check the associated box.) 0 W)IN am a tennis quantity gvharatoG I cenily Nat I have a program In place to reduce Me volume and toxicity of waste generated to tM degrea I have determined to to aconomlcally Maeficabla and that l have selected the practicable method of treatmonh storage,or disposal currendy available to me which minimizes the present and future threat to human l ifs and Me eneiromenh Oaifioma amen quantitygemrator,I have made a good frim.)fort to minimise my waste 1-h 6.and select.the beat waste'men agemenimethod that bavaitable ) to m•[hat geag41fyord. a'y,• - -.J!3r � Date Customer --- `"" DateDriv�"rSignaure i Print Name - - Print Drivers Name;