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r <br /> FRESNO = SERVICE ORDER NO. <br /> 559-498-0240 <br /> 6ICO OFFICE <br /> 0-733-9043 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE, COMPTON,CA 90221 <br /> S 1-310-886-3400 <br /> H TRANSPORTER EPA#CAD028277036 <br /> P <br /> P <br /> E <br /> D <br /> T <br /> 0 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# I DESCRIPTION QTY UNIT PRICE QTY PIU TOTC <br /> TOTAL <br /> VFASH REC'D: <br /> CHECK#_ PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,, LIQUID(USED LIQUID(ETHYLENE GXED OILS)*NO PLACARDS REQUIRED* STATE CODE 22 <br /> NON-RCRA HAZARDOUS WASTE, 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 /> RUMS PN: <br /> EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> s is to certify that the waste described above o hereby certify th ified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applies <br /> federal regulations.By signing <br /> below(Waste oil generator/customer MUST check ONE of the followmngdththereetboxes e does not contain any <br /> I have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS t <br /> �) than 1,000 pp <br /> 1)1ioiwith the requirements of the applicable Ca <br /> iiforn rincoe ted oil management regulations to determine this Is true.I agree to accept the additional charges for the disposal <br /> e information I have provided about this waste s <br /> I 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 <br /> Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.I agree to accept the at <br /> provided proper documentation t <br /> ie disposal of this waste if the information I have provided about this waste is incorrect quantity enerator CESQG)sources.To the t <br /> mpt <br /> This waste is from a tank which collects waste <br /> CEil from collection ankoistsoley from DIY)andlor CESQG soulrcese have nolt mixed this waste oil with any other hazardot. <br /> ledge,the only waste oil contained in my D ` <br /> oil from other sources.I agree to accept the additional charges for disposal of this waste if the information I have and about <br /> the te'ass�ated s inco4lrect �x�l <br /> (All generators/customers MUST read the following <br /> nested to the degree 1 have determined to be I <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste 9eesent management method tha <br /> :able and that I have selected the practicable method of treatment,storage,or disposal currently availste generation me <br /> and selecttthe best wizes the aste turn threat o ur <br /> vironment,Or,if I am a small quantity generator,I have made a good faith effort to minimize my <br /> wl <br /> !tat I can afford. <br /> _—I_i nt;%jpr Sianature <br />