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;;-800-,'-f4SB(lRY <br /> FORM NO AEsopy_g(REV IM7-1 <br /> FRESNO �_ __ � <br /> 559-498-0240 = SERVICE ORDER NO. <br /> — <br /> 2HlCO OFFICE0 v <br /> CHI CO 9043 --J-- <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE, COMPTON.CA 90221 <br /> M 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 HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> { Q_ ') t _� i <br /> PART# DESCRIPTION QTY UNIT PRICE I QTY PIU I TOTAL <br /> TOTAL <br /> NSH 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 /> !MS PN: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> 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 Stat <br /> feral regulations.By signing below I also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> 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 t <br /> �d 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 H <br /> formation I have provided about this waste is incorrect <br /> lave not mixed any of the waste described above with any other nazardous waste,the total halide content is GREATER than 1,00o ppm,and the waste does not contain any PCI <br /> wided 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 i <br /> isposal of this waste if the information I have provided about this waste is incorrect <br /> is 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 of m, <br /> ge,the only waste oil contained in my DIY/CESQG collection tank is coley from DIY and/or CESQG sources.1 have not mixed this waste oil with any other hazardous waste <br /> 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 /> 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 <br /> e and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat o h <br /> nment;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 <br /> I can afford. <br /> nr Cinnnfi rre na}p Driver Signature <br />