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DIXONOFFICE • SERVICE ORDER <br />1-800-7-ASBURY FORM NO AES004-B (REV 10/071 <br />UNION CITY OFFICE —�_ = SERVICE ORDER NO. <br />1-888-603-8844 — <br />s <br />ASBURY ENVIRONMENTAL SERVICES <br />H 1300 SOUTH SANTA FE, COMPTON CA 90221 <br />H <br />1 <br />p <br />P 1-800.974-4495 <br />E <br />D <br />r <br />TRANSPORTER EPA # CAD028277036 <br />__ <br />CHECK # <br />TION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) NO PLACARDS REQUiREW <br />STATE CODE <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED" STATE CODE <br />221 <br />OTHER: <br />DESIGNATED TSDF: <br />ALTERNATE TSDF: <br />CFR: 33210 Western Avenue, UnionCity, CA 94587 (510— ) 487.9277 <br />DRUMS <br />i4t1t <br />FACILITY: BS <br />PLEASE CHECK THE APPROPRIATE BOX <br />This Is to certify that the waste describetl above is property daasified, dpuibed, packaged. marketl and labeled. and is in proper corWilion for tranaportafion, according[o <br />and federal regulations. By signing below I alae herby certify that: <br />applicable State <br />(Waste oil generator/customer MUST check ONE of the following <br />D 01)1 have not mixed any of Me waste described above with an other h n three boxes) <br />Compiled with the requirements of the applicable California used oil man hazardous waste, the total batitle coolant I. LESS than 1,000 ppm, and Me waste tloas not contain any PCBs,1 have <br />if the Information I have provided about this wsafe Is incorrect agement regulations to determine Mis Iz true. 1 agree to accept the additional charges for the disposal of this waste <br />0 f12)1 ho not mixed any of Me waste described above with any other hvardoue waste. Me total halide content is GREATER than 1,000 ppm, and the waste does not contain any PCBs. l <br />have Provided proper dvcumrmtatlon to Asbury Environmental Services to rate[ the presumption Mal this waste was mixed with other hazardous waste. I agree to ecce <br />for the disposal of this waste if Me Information I have Provided about Mle write is Incorrectpt Ma additional charges <br />0 JIO) This waste is 9rom a tank which collects waste ofi from household'dor4younelr (DIY) antllor cOndimmally exempt small quantity generator (CESQG) sources. To Me best of my <br />knowledge, Me only waste oil contained in my DIY/ CESQG collection tart fs s01ey from DIY and/or CESQG sources. 1 have not mixed Mis waste oil with any other hazardous waste m <br />waste oil from other sources,) agree to accept the additional chargee for z4spoatl of this waa[e if Me iMonnation 1 have provided about Mis waste is incorrect <br />(All generators/customers MUST read the following text and dtedk the a <br />0 N4) g' am a large quantity gsneratoz, I certify that I have a program numeandtoxicity associated determined to be economically <br />prateficabie and that 1 have selected the practicable method of treatment Morelia, reduce <br />disposal currently available to mo which minimizes the rresent and future threaterated to the degree I have to human life and <br />theenvironment; r, if I am a small quantity generator, I have made a gaud faith <br />tome that I canafford.,IWon to minimize my weate generation and select the best waste management method that is available <br />Customer Signature Date— <br />DriverSignature Date <br />rent Name <br />Print Drivers Name <br />