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FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-7-ASBURY <br />UNION CITY OFFICE <br />1-888-603-8844 <br />CHICO OFFICE <br />800-733-9043 <br />BCS REFINING LLC - L.5001 <br />222 S SINCLAIR AVG <br />r STOCKTt7i N CA 46216 <br />D <br />• SERVICE ORDER <br />M N0. AE5004-B (REV 10107) <br />MERVICE ORDER NO. <br />I� = ISI—//'' DEC 01 2014 '1t 'ak ei a <br />ASBURY ENVIRONMENANWPQWI MENTAL HEALTH <br />1300 SOUTH SANTA FE, COMPTON, DWA:HTMENT <br />1-310,886-3400 <br />TRANSPORTER EPA # CAD028277036 <br />705 REED STREET <br />Suints Clara, CA 850$0 <br />(408) M7060 <br />CUSTOMER # <br />PURCHASE ORDER # <br />ROUTE # <br />TRUCK # <br />CONTACT NAME <br />ORDER TAKEN BY <br />HALIDES <br />DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE <br />CUSTOMER EPA # <br />MANIFEST# <br />i1t2iN2014 <br />1112412014 <br />PART # DESCRIPTION <br />QTY <br />UNIT PRICE <br />QTY PIU <br />TOTAL <br />USED CftL SERVICQ CHAR3L <br />hJ1C USED Oii- I MIXED OILS' <br />aSsA1 ^"*ALL TWO HRS BEFORE ARANAU11400 76040%BEVERLY KENNEDY BAT <br />R <br />TOTAL <br />CASH RECD: CHECK # PLEASE PAY FROM THIS SERVICE ORDER <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 />Y <br />DESIGNATEDTSDF:c)�_-ri-4�-1-:.•:•,+.N elif?N,94'""- <br />ALTERNATE TSDF: <br />SA RECYCLING: 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br />DRUMS PIU; EMPTY DRUMS: FACILITY,. -BSC <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />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 State <br />and federal regulations. By signing below I also hereby certify that: _ <br />(Waste oil generator/customer MUST check ONE of the following three boxes) <br />Ysa #t) I 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 <br />¢mplied 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 <br />lith( information I have provided about this waste is Incorrect <br />0 #2)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 <br />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 the additional charges <br />for the disposal of this waste if the information I have provided about this waste is incorrect <br />0 #0) This waste is from a tank which collecte waste oil from household "do-il-yourself" (DIY) andlor conditionally exempt small quantity gen eralor (C ESQG) sources. To the best of my <br />knowledge, the only waste oil contained In my DIV/ CESOG collection lank is coley from DIY and/or CESQG sources. I have not mixed this waste oil with any other hazardous waste or <br />waste oil from other sources. I agree to accept the additional charges for disposal of this waste if the Information I have provided about this waste is Incorrect <br />(All generators/customers MUST read the following text and check the associated box.) <br />a) I/ I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />�.r:o <br />cticablnd that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and uture threat to human life and <br />env�ro�menl Or, it I am ar Sna I q entity generator, I h v! made a good faith effort to minimize my waste generation and select the bust waste marfag enl method that is available <br />to malhail7,1 Hob: _ <br />�` <br />Customer Signatu / } Date <br />1.4171 Yloin/9P d, <br />Driver <br />Date <br />