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• FORM NO AES004.8(REV I NTI <br /> SERVICE ORDER NO. <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 SOUTH SANTA FE,COMPTON,CA 90221 <br /> 1-310-886-3400 <br /> TRANSPORTER EPA#CAD028277036 <br /> # PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> RED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL <br /> TOTAL <br /> CHECK#_ PLEASE PAY FROM THIS SERVICE ORDER <br /> RECD:�— <br /> WASTE DISPOSAL INFORMATION -STATE <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENASTE, LIQUID(USED E GLYCOL SOLUTIONS)NO PLACARXED OILS)-NO PLACARDS DRED- <br /> S REQUIRED- STATECCOODEDE 221 <br /> NON-RCRA HAZARDOUS <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br /> SUMS PN: <br /> EMPTY DRUMS:__ FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> is to certify that the waste described above is property classified,described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State <br /> federal regulations.By signing below I also hereby certify that: <br /> mer MUST <br /> ee <br /> does not <br /> (Waste oil generator/custoach teckoONEtent sofSthe fol <br /> lowingpt the additional charges for the disposal of this wa <br /> oppmngdtthe h waste contain any PCBs.I ha <br /> with any other hazardous waste, boxes) <br /> I have not mixed any of the waste described above <br /> died with the requirements of the applicable California used oil management regulations to determine this Is true.1 agree to acce <br /> information I have provided about this waste is incorrect m,and the waste does not contain any PCB <br /> I have not mixed any of the waste described above with any other nazardous waste,the total halide content is GREATER than r hazj,000ardous <br /> pp <br /> documentation to Asbury Environmental Services this rebut the presumption <br /> re u ption that this waste was mixed with other hazardous waste./agree to accept the additional c'. <br /> trovided proper <br /> disposal of this waste if the information I have provided aboutgenerator CESQG)sources.To the gest of my <br /> l with any <br /> G collection tank is coley from DIY and/or CESQG sources.ave provided about this waste is incorrect <br /> other hazardous waste e <br /> this waste is from a tank which collects waste oil from household"do-it-yourseir(DIY)and/or conditionally exempt small quaned this waste tity <br /> ,d9e the only waste oil contained in my DIY/CESQ rated bOX.� <br /> til from other sources.I agree to accept the additional charges for disposal of this waste i(the information to and the assoc <br /> (Alt generators/customers MUST read the following generated to the degree 1 have determined to be economic <br /> !am a large quave selected the practicable method of antity generator,I certify that I have a program in place to reduce the volume and toxicity of waste <br /> esent and future threat to human file ac <br /> e neration and select the best waste management method that is avail' <br /> able and that I htreatment,aood faith effort to minimize my waste ge <br /> tment,storage,or disposal currently available to me which minimizes t e Pr <br /> ronment;Or,if I am a small quantity generator,I have m 9 <br /> at I can+Nord. <br /> Dat <br /> Driver Signature <br /> nate <br />