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FOR SERVICE CALL: <br />SERVICE ORDER <br />DIXON OFFICE <br />1-800-7-ASBUP,Y <br />Nuc <br />UNION CITY OFFICE <br />1-888-603-8844 <br />60 ��� = <br />CHICO OFFICE <br />e <br />r , <br />800-733-9043 <br />�/�J <br />ASBURY ENVIRONMENTAL SERVICES <br />S 1300 SOUTH SANTA. FE, CCMPTON, CA 90221 <br />•1-310-886-3400 <br />p TRANSPORTER EPA r CAD028277036 <br />P <br />E <br />D <br />T <br />0 <br />l�i+STOi4s`•:ER# i PURCHASE ORDERS ROUTE? T?5.T '`; z;: i r^WT4,r-T. Kl aPo <br />;iii E REQU1REDI �r.TE ENTERED NEXT SERVICE DATE � CUSTOMER <br />1 , <br />DESCRIPTION QTY I <br />CASH REC'D: CHECK <br />FORM NO. AES004-B (RFV 10W) <br />SERVICE ORDER NO. <br />ORDER TAKEN BY HAUDE.1 <br />UNIT PRICE I QTY P/U i TOTAL <br />! I iTOTAL ! <br />PLEASE PAY FROM THIS SERVICE ORDER <br />WASTE DISPOSAL INFORIIJI TION? _ <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL /MIXED OILS) -NO PLACARDS REQUIRED" STATE CODE 22 i <br />NON-RCRA HAZARDOUS yl4/,ESTE, LIQUID (ETH'?LENE GLYCOL SOLUTIONS) *NO PLACARDS REQUIRED` STATE CODE <br />O'T'HER: <br />DESIGNATED TSDF: - - - — <br />ALTERNATE- TSD - - i -- <br />SA RECYCLING: 33210 Vilestern Avenue, Onion City, CA 94587 1-510-407-9277 <br />IDRUMS PIU: EMPTY DRUMS: FACILITY: BSC I <br />GENERATOR WASTE CERTIFICAT iON — <br />PLEASE CHECK THE APPROPRIATE BOX <br />This is to certify that the waste described above is properly classifi d, described, packaged, marked and labeled, and is in proper condition for transportation, according to applicable State <br />and federal regulations. By signing below I also hereby certify that:r <br />,Jasi dig genes -.3 /customer lUS7 check ONE Of Une aollowing <br />❑ :1) I 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 />conplied 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 />D ;,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. 1 <br />have provided 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 charges <br />for the disposal of this waste if the information I have provided about this waste is incorrect <br />D 03) This waste is from a tank which collects waste oil from household -do-it-yourself" (DIY) and/or conditionally exempt small quantity generator (CESOG) sources. To the best of my <br />knowledge, the only waste oil contained in my DIY/ CESGG collection tank is soley from DIY andlor CESOG sources. I have not mixed this waste oil with any other hazardous waste or <br />waste oil from other sources. I agree to accept the additional charge for disposal of this waste if the information I have provided about this waste is incorrect <br />(.All genes ators/customdrs MUST read the fallowing text and check the associated bex.) <br />D 04.) If I 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 economically <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human life and <br />the environment; 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 available <br />to me that I can afford. <br />Custofner Signature <br />Pi -Int Name <br />/_1. <br />Date <br />Driver Signature <br />Print !Drivers Name <br />--I-/- <br />Date <br />