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FOR SERVICE CALL: is SERVICE ORDER <br /> DIXON OFFICE • <br /> FORM NO.AES004-B(REIT 10/07) <br /> 1-800-7-ASBURY I SERVICE ORDER NO. <br /> UNION CITY OFFICE _ <br /> 1-888-603-8844 _ <br /> ASBURY ENVIRONMENTAL SERVICES <br /> S 1300 SOUTH SANTA FE,COMPTON, CA 90221 <br /> H JTI 3 ) £_t,l4,tr 1-310-866-3400 g1(;'t2rfllt ll : Ii!!; <br /> I r r, s TRANSPORTER EPA >st e <br /> P , ; 1 '� hl,; Irlt =T t.1 a1' C- 1 •1 r #13f71 <br /> P <br /> E <br /> D <br /> T <br /> O <br /> CUSTOMER# PURCHASEORDER# ROUTE# j TRUCK# CONTACT NAME ORDERTAKENBY HALIDES <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> 1447 17777 i l 1.l T ri_Y. . 0 f f x,__-1 <br /> ,r <br /> TOTAL <br /> ASHREC'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: fiat tt t'varli„ �szA ifr� uVOW IA I,'. j�,1,�13P' I i Pfl 1',t ;.R t o-i_tiuA� f'-.i ut,cf ,:n.,. <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF. <br /> CFR: 33210 Western Avenue, Union City, CA 94587(510)487.9277 <br /> DRUMS PN: 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 property classified.described,packaged,marked and labeled,and is in proper condition for transportation,according to applicable State <br /> and federal regulations.By signing below 1 also hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> I #i)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 PCBs.I have <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 this waste <br /> if the information I have provided about this waste is incorrect <br /> 0#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 any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.)agree to accept the additional charges <br /> for the disposal of this waste if the information I have provided about this waste is incorrect <br /> 0#3)Tbis waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)andlof conditionally exempt small quantity generator(CESQG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is Soley from DIY andlor CESQG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waste oil from other sources.I agree to accept Ne additional chargee for disposal of this waste if the information 1 have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> 0#a) If I am a large quantity generator,1 cenity that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimize$the present and future threat to human life and <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 beat weals management method that is available <br /> me Nat 1 can afford. <br /> Customer Signature Date Driver Signature Date <br /> Print Name Print Drivers Name <br />