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y� R/ FORM NO.AES004-B(PEV 10107) <br /> .SERVICE ORDER NO. <br /> MAY e �Ot5 <br /> _ -_-- <br /> EAL <br /> ASBURY ENVIRONMEdTAL SE '11I'yF ( @ i , <br /> 1300 SOUTH SANTA FE,COMPTON� nc�npT4ar_r,1-T' <br /> 1-310-686-3400 <br /> -7 TRANSPORTER EPA4 CAD028277036 261 W GRANTl..It!E, <br /> RClAD <br /> F1C� TRAC)f, CA <br /> o.fes.. :. . .. <br /> `' �'� ' �:�I S�€I •A;101 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> I'-DDI iIIJLIc� Iq:►ChlrCU <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U TOTAL <br /> l„ 1 M_R PEP DR1.1M <br /> fER pF, :u"e9 :1 t± <br /> - Z25 !�a S 1,125 0C <br /> .: h'5•�CS, UVL'C K0i\i:)N ,CiK1 BD22x ' 'X.?ell911� TOTAL <br /> CASH CHECK# PLEASE PAY FROM THIS SERVICE ORDER <br /> RECD <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)'NO PLACARDS REQUIRED` STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)*NO PLACARDS REQUIRED' STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTERNATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 <br /> DRUMS PIU:�' EMPTY DRUMS: FACILITY'- I/ BSG <br /> GENERATOR'WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE BOX accordin to applicable Stale <br /> This is to certify that the waste described above is property classified,described,packaged,marked and labeled,and Is in proper ebndition for transportation, 9 <br /> and federal regulations.By signing below 1 also hereby certify that: <br /> (Waste oil generator/customer MUSE check ONE of the following three boxes) <br /> 0 #1)1 have not mixed any of the waste described above with any other hazardous waste,Ne total halide content is LESS than 1,000 ppm,and the waste does not contain any a th a 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 dispose of Ihlwaste <br /> If the Information I have provided about this waste is incorrect <br /> cont <br /> 0#211 have not mixed any of the waste described above with any ewer nawrdous wastu, p,,m,.l halidu contonl is GREATER than r hazardous <br /> ppm,and the waste to <br /> not t the <br /> any PCBs.I <br /> have provided proper documentation to Asbury Environmental Services to reuul the P,usumpiion mat rM1is waste was mixed with Other hazardous wasle.l agree to a<cdpt[na addidenal charges <br /> for the disposal of this waste if the information I have provided scout this waste is incorrect <br /> 0#3)This waste is from a Unit which collects waste oil from household"do-it-yourself'(DIV,mWlor conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIYI CESOG collection tank Is sully from DIY auu:or CESOG sources.I have not mixed this waste oil with any other hazardous waste or <br /> waste oil Iron other sources.I agree to accept tho additional charge.for disposal of this waste II the information I have provided about this waste is Incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> etemfpracdcabla and that Ihaed to the degree I have d <br /> ve seUcledathe practlicable m thod olheamlent,s,ufage,rof disposal ceduce the mmndy available to meand toxcilY of swhte c h minimizes the present and future ththlreat3Q human life and economicallyned to be <br /> Ne environment;Oq if 1 am a small quantity generatorl,Fltet'e mada a goub IaiN effort to minimim my weals gnnention and select the bast waa>�rrr,4a ��'h lhet is available <br /> 41h.tord. % ` �1s1 y1 yDategnature Date <br /> neer Si nature e <br /> Print Drivers Name <br /> U <br /> Print me ' --------' <br />