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FOR SERVICE CALL: SERVCE ORDER <br /> OtXON OFFICE <br /> 8W-7-,o�SBURY SERVICE ORDER NO. <br /> FRESNO <br /> 559-498-0240 <br /> WE <br /> i1CO OFFICE <br /> _J0-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON. CA 90221 F.G V E <br /> 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> MAR 2 8 2016 <br /> ENVIRONMENTAL <br /> ACUS T ER R# 7 HASP 7D_ER T_ r7E#t —TRUCK# C 0 N�r7A_CCTT Fk 2 df EORDE�R'T&KE"N13z' HALIDES <br /> _T <br /> JDATE REQUIRED! DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MAMFEST <br /> FIC'�C R 'TAA mm. ,r QTY dtiiT j TOTAL <br /> II <br /> TOTAL <br /> ..ASH REC'D: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> — NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED 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 /> SARECYCLING,- 33210 Western Avenue, Union City,CA 94 587 1-510-487-9277 <br /> DRUMS PIU. EMPT`;'DRUMS: FACILITY: BSC_ <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> .ha .;.r.:.ert,ty rt tr,:,:� e a�r,c: .: zr.>:,. .�y.�eri y, ass�yit�d,described,Packaged.marked and labr,led,and�s in propor ee�ndioerri tear hanspo,tn.t un aacou;ing to appilcabk�Mare <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 /> 0 #1)A 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 iontaon any PCBs.I have <br /> complied with the requirements of the applicable California used oil management regulations to determine this As true-I agree to accept the additional charges for the disposal of this waste <br /> it the information t have pmvsdecl about this waste is incorrect <br /> 0 92)1 have not mixed any of the waste described above with any other nazardous waste,the total halide content is GREATER than 1.000 ppm,and the waste does not contain any PCBs.A <br /> have provided proper documentation to Asbury Environmental Services to rebut the pfesumption that this waste was mixed vath other hazardous waste.i agree to accept the additional charges <br /> for the disposal of this waste it the information A have provided about this waste is incorrect <br /> ,7j#3)This waste is front a tank which collects waste oil from household"do-it-yourself'(01Y)andlor conditionally exerript small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil comained in rely DAY/CESOG collection tank is coley from DAY and/or CESOG 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 A have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 094) if I am a large quantity generator,A Certify that I have a ptograrn in place to reduce the volume and toxicity of waste generated to the degree I have determined to be eccnormcally <br /> ,racticilble and that I have selected the practicable method of V"atment,storage,or disposal Currently available to me which minimizes the present and future threat to human life and <br /> ie environment;Or,it i am a small quantity generator,A have made a good faith effurl to mininitze my waste generation and select the best waste management method that is available <br /> to me that I Cain afford. <br /> Customer Signature Date Driver Signature Date <br /> Print N;kmi- Print Ilirivem Nirrw, <br />