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1.01 <br /> "++' VICE ORDER <br /> FOR SERWE CALL: cORM NO.Af.S00d-R(REV 10107) <br /> DIXON OFFICE — SERVICE ORDER NO. <br /> ',.8W-7-ASBURY <br /> UNION CITY OFFICE '= s <br /> 1-888.603.8844 � — �- <br /> _ ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> s 1-310-888-3400 <br /> p NAXII`1., 'i:'-RANF.. '4i1"aRK;3 TRANSPORTER EPA CAD028277036 tAa'KTt`1 �Ck2a41�IC it}fJl't1C:3 <br /> p +'i3 itiAft"PtF )r3A i•UAD P(1 130% 9U� <br /> j D < <br /> et <br /> ,. , naRr rX <br /> f; o 'TIJI hri1N, CA 9'.'ii@i"• i.1f31 ) '471 ..3766.. <br /> 73 rr 1 it'1^: 1C 5. <br /> CUSTOMER# . PURCHASEORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> h <l> }wit fY';Sil1 <cas3ra <br /> TEREQUIR D DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> r'/' :i/•,riyy(�}y r!''2/20 0.9 i "1i!'P'.y ?', iei4-'i . ) .:.')� v !, <br /> PART#. DESCRIPTION QTY UNIT PRICE CITY PIU TOTAL <br /> i'�SiJi,A.Y,4f.E r l!t L SUtl( HA'kGf 1 <br /> ce., ��• <br /> del tit .iJ irtlJ M()ps arT T'C)N I)fi(!i (f(i:C;I�i;:7t i il.iY}3?1)) n <br /> y, OT..! Y WLY tatJt.71}� PEre -DRUM <br /> II <br /> r <br /> TOTAL <br /> CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER' ". <br /> F WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED 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 /> t L.. ALTERNATE TSDF:. <br /> CFR: 33210 Western Avenue,Union,City,CA 94587(510)487.9277 <br /> DRUMS PN: EMPTYDRUMSi FACIUTY: BSC <br /> GENERATORWASTE CERTIFICATION. <br /> PLEASE CHECK THE APPROPRIATE.BOX <br /> Tnb ism certlfy tlW she wasm Waerlbed above la properly cl ossified,described packaged,marked,rdiabted,and,ain propo <br /> c citlon fortrnnsponlion,aecrndingto applicaole Smto <br /> and federal ra il.tions:By signing below l A.hereby canny that <br /> (Waste oil generator/Customer MUST check ONE ofthe following three boxes) <br /> 0/1) have not mfxe0 any of the wseto deecnbed above wlm any other hazndo s aster.Ne total hal de center!IS LESS Nan 1,900 ppm,end the waste does not contnn any pCe..I have <br /> 0 J) hve am wendrequirementsMof he..aappllcable California used 011 mam9amonl/pumlion toet me Nis la hued.pre if*accept the.additional charge.for me disposal of this waste <br /> it Ne Information l have.pmeid.d about ...age- <br /> this <br /> este la incorrect <br /> is <br /> IZAiTER <br /> I ON <br /> s net contain <br /> e t <br /> u• 0/9)lhavenotrateda Came wore MaeribedvimnmenW Barvomm h,w,the presu ption that thy.haseeass waste,Me total is waste waemxed with other hazadousand <br /> wool.l agreem cep the soea0onacaharge. <br /> have provided proper des,, nm9an to Asbury <br /> forma disposal of MIs waste if me Inbrmedon I h..provided about this wtlte a imorre t <br /> •.', G/9)Thb waste is from.lank which.collects waste ell from household"do-it-youreed"(MY)Soler co�wmoimllyexempt small quanhty generaler(CESGG)yo the,t Tolbebesto(my <br /> kitowlsdge,the odlrwaab oil wnmined in my DIY/CESDG collection lank is Way from DIY ardr.,CESQG sources.I have hot raised this waste oil with any other ha artlourwbu or. <br /> .:I wulaoilit,the have only <br /> waste if....wood <br /> in me addNorulsharges forCNpoNl d mi...to 4Oil-nformatiml have provided about No waale is incorrect j <br /> (Allgenera MUST read the following text and Bleck the associated box- <br /> D N4)It 1 am a largo quantity 9enanlor;I codify that I have a pogrom In pWea-reduce the volup end mxkittallY <br /> y or waste generated to Nv degree I here da..threat <br /> e t to th s en life and <br /> prxgcablo and Nat I have Selected me pracdcable method of treatment,storage,or disposal cumently available to rrla With ee,homin es the pasmt and mment method that is available <br /> me enviremBnl;Or,it lame small quantity generator,I have made A good faim eNon to mininun.my..at.gananBen and aolecl the best Watl?Irl <br /> tom Nnlc natf d. .✓°'~ "� <br /> .._-0river Siglw ro Date. <br /> ' Customer Signature <br /> Date <br /> L`?.• `. Print Drivere,Name: <br /> Clint Name - <br />