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FOR SERVICE CALL: DIXON OFFICE 1-800-7-ASBURY FRESNO 559-498-0240 CHICO OFFICE 800-733.9043 9225745 720 _ ,'.`r'.�f _. � — CA 952', a (209) G5` -24i";, A i SERVICE ORDS ,.; FORKING AES004-8 (FF! 10.107) SEP I ai5 SERVICE ORDER NO. ?c�; ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE, COMPTON, CA 90221 1-310-886-3400 ONES RESOURCE ='.RE TRANSPORTER EPA # CAD028277036 3175 MA 1 N STREE'-, S "Ty 420 PRISVO. TX 730'3Z :972) Lt,J4.01Ci .-' CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES FIRU=`"�567?: S ioacheca 201 DATE REQUIRED DATE ENTERED NEXT SERVICED TE CUSTOMER EPA # MANIFEST # � 9/ 12 a .1�, ., 5 ....t_z62 , , , l 3�n ,� 1�2 0 �n3 G 0 PART # DESCRIPTION QTY UNIT PRICE QTY PtU TOTAL 55 -of -11-11, 55 :3AL:_^NI O>- TOc' DRIJIN! 1RD10NF�T 0QNE'_ Ac -ROSS �'•f,� ' c. K:ROSG_S •-- TOTAL CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL. INFORMATION' NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS)'NO PLACARDS REQUIRED' STATE CODE 221 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED" STATE CODE OTHER: DESIGNATED TSDF: ALTERNATE TSDF: SA RECYCLING: 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 DRUMS PN: L 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 transportation, according to applicable State and federal regulations. By signing below I also hereby certify that: (Waste oil generator/ customer MUST" check ONE of the following three boxes) 0 91)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. 1 have complied with the requirements of the applicable California used oil management regulations to determine this Is true. t agree to accept the additional charges for the disposal of this waste it the information I have provided about this waste is incorrect 0 42)l 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 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 Ute additional charges tot the disposal or this waste if the information I have provided about this waste is incorrect 0 93) This waste is from a tank which collects waste oil from household "do-it-yourself* (DIY) andlor conditionally exempt small quantity generator (CESQG) sources. To the best or my knowledge, the only waste oil contained in my DIYI 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 Ute additional charges for disposal of this waste it the information 1 have provided about thl3 waste is incorrect (All generators/customers MUST read the following text and check the associated box.) K14) Ili am a large qu tity generato , 1 certify. a! i have a program fgplaco to reduce the volume and toxicity of waste generated to the degree,[ have determined to be economically practicable an hat 1 h a selected the practfca attiod of treatment, storage, or disposal currently available to me which minimizes the present and fu t to human life and the env me r, it m a Finall quantity an t , I have s a good faith effort to minimize my waste generation and select the best waste agement ethod that Is available tomethat1car a old.- Date L/Drivt r Ignature y. — Print Drivers Name _07 Date