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°w-f-ASBURy FORM NO AES004-B(aE1f1M7'j - <br /> FRESNO - — — SERVICE ORDE <br /> 559-498-0240 <br /> ftL <br /> laFICO OFFICE <br /> I ot10-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> N 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> i 1-310-886-3400 <br /> P TRANSPORTER EPA#CAD028277036 <br /> P <br /> � E <br /> D <br /> T <br /> O <br /> CUSTOMER—# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDE <br /> DATE REQUIRED I I DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOT <br /> r' <br /> TOTAL <br /> SH 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 /> SA RECYCLING: 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br /> DRUMS P/U: 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 applicabl <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 /> ❑ #1)1 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 PC <br /> complied 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 <br /> if the information I have provided about this waste is incorrect <br /> ) #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 an <br /> ave 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 additi <br /> :or the disposal of this waste if the information I have provided about this waste is incorrect <br /> #3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/or conditionally exempt small quantity generator(CESQG)sources.To the best <br /> towledge,the only waste oil contained in my DIY/CESQG collection tank is Soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous w <br /> aste 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 /> #4) If 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 econ <br /> bcable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human I <br /> environment;Or,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is a <br /> ne that I can afford. <br /> Istomer Signature Date Driver Signature <br />