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-FOR SERVICE CALL: SERVICE ORDER DIXON OFFICE FORM NO AES004-B IQEV 10/071 1-800-7-ASBURY _ SERVICE ORDER NO. UNION CITY OFFICE7,"y::,^, ', 1-888-603-8844,, BEEF CHICO OFFICE 800-733-9043 ASBURY ENVIRONMENTAL SERVICES S 1300 SOUTH SANTA FE, COMPTON, CA 90221 H _ 1-310-8$f;3400 Ph Lf(3ER•1. 1f F"I fd:7 I) l:`JF"' ("T i..T Bj�SPORTER EPA#CAD028277036 .E ?4i ,:'4 N fiRU'VM-I,..A RP 24.1.24 #�- P};}.11.}...I..� RD D y•r I^CAMF'O, CA ryt J».20 CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES r STAN Lf DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# .1 4/ '01.f3 :}: t.t;4/:201IJ i';-AL 000 2:I.h460 PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL C)fSk:.:lr C1 T:}. �il�ll::) 6AtS(.JI...'1'N[` $312. 00 I cry. f �. 1 F r)-TUMULf"ll t:l:,N TOTAL CASH RECD: CHECK# PLEASE PAY •OM 7444S SERVICE ORDER WASTE DISPOSAL INFORMATIO NON-RCRA HAZARDOUS WASTE, LIQUID(USEPOILJM14b OILS)*•NORbA CARDS•REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL DN 'NO PLACARDS REQUIRED" STATE CODE OTHER: DESI"ATED TSDF: ALTER`JATE TSDF: - LLJ SA RECYCLING: 33210 Western Avenue, Union Clty,CAf94587 1,`510-487-9277 �. DRUMS PIU: '"� EMPTY DRUMS: FACILITY: BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE,APPROPRIATE BOX This is to certify that the waste described above is property classified,described,packaged,marked and labeled,and is in proper condition for transpot_tation,according to applicable State and federal regulations.By signing below I also hereby certify that: (Waste oil generator/cus�mer,(4UST check OE of the following three boxes) ❑ #7)I have not mixed any of the waste described above with any other hazardous waste,the total halide contEnt•is LESS than 1,000 pqm,and the waste does not contain any PCBs.t have complied with the requirements of the applicable California used oil management regulations to detrmine this Isi,true.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect 0#2)1 have not mixed any of the waste described above with any other nazart4ous waste,the total ha11de contenDis GREATER than 1,OQ¢.ppm,and tftitwaste does not contain any PCBs.I have provided proper documentation to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazitrdous waste.1 agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste is incorrect 0#3)This waste is from a tank which collects waste oil from household"do-it-yourself'(DIY)and/dr conditioriaily exempt small quantity gaYterator(CESQG)sources.To the best of my knowledge,the only waste oil contained in my DIY/CESQG collection tank is soley from DIY and/or CESQG sources.I have not mixed this waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional charges for disposal of this waste if the information 1 have provided4`4tsut this wastels Ir borrect (All generators/customers MUST-read the following text and beck the`associated box.) ❑#4) If I am a large quantity generator,I certify that I have a program in place.Io4r4duU):he volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatment,storage,eS disp''hsal curr4l;Vy available to me which miV,miies the present and futdre threat to human life and the environment;Or,if(am a small quantity generator,I have made a gbodfaith effoltte4ninimtze my wafte{*neratI and"isCtthe best wastb managenjent method that is available to me that I can afford. _ �LY L Q'�te V. Driver i ture ^ Date Customer Signature •:l 1 , 9 Print Name Print Drivers Name