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FOR SERVICE CALL: <br />DIXON OFFICE <br />1-800-7-ASBURY <br />FRESNO <br />559-498-0240 <br />CHICO OFFICE <br />800.733-9043 <br />Cllr 'i?F�iC �w_J, T[I'SF. <br />-C 7. '-�Ari MIMER LA'vr <br />STOC KTON. CA <br />r2f)959-2403 <br />ia 4 <br />SERVICE ORDEh`- <br />FORM NO AESf,.Od-9 tRfy 10i07) <br />ESERVICE ORDER NO. <br />�= <br />qmm IT eao57 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA # CAD028277036 <br />OJE-ST REESOJRSc MGP! - I -IR` <br />-3 75 -N, A! IN, STI-.- SLITC- G20 <br />; 972) 464-0004 <br />CUSTOMER # <br />PURCHASE ORDER # <br />ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br />P1P.02 % <br />? 3Uc'r716 <br />86 A?�� f ioacheco <br />DATE REQUIRED <br />DATE ENTERED <br />NEXT SERVICE DATE CUSTOMER EPA # MANIFEST # <br />913/20 1 - <br />912/2015 <br />CAi_11300366214 '` <br />PART # <br />DESCRIPTION <br />QTY UNIT PRICE <br />QTY PIU <br />TOTAL <br />pzv«-. <br />GALLONn�T�'lP DRUMiy.d-E..nN9�^, <br />Y S0 <br />011-'y SOLIDS PER z"JIM <br />a4-Gi.< <br />Sri <br />S*r"I�: <br />TOTAL <br />CASH RECD: CHECK# PLEASE PAY FROM THIS SERVICE ORDER <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 PN: C 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 properly classified, described, packaged, marked and labeled, and is in proper condition for transportation, according to applicable State <br />and federal regulations. By 31gning below I also hereby certify that: <br />(Waste oil generator/ customer MUST check ONE of the following three boxes) <br />0 01) 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 />complied with the requirements of the applicable California used *it management regulations to determine this Is true. I agree to accept the additional charges for the disposal of this waste <br />if the information 1 have provided about this waste is Incorrect <br />0 02)1 have not mixed any of the waste described above with any other hazardous waste, the total halide content is GREATER than 5,000 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. 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 />0 03) This waste Is from a tank which collects waste oil from household "do•It•yourself' (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my <br />knowledge, the only waste oil contained in my DIPJ CESQG,collection lank Is, soley from DIY andlof 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 the additional charges for disposal of this waste if the Information I have provided about this waste is Incorrect <br />�//'� (ABI generators/customers MUST. read the following text and check the associated box,) _ <br />jt'x4) If E am a large quantity generator, I certify, that I have a pr am in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />raclicable and that I have sp•led the practice method o r al ent, storage, or disposal currently available tome which minimizes the present and future threat to human life and <br />the envEronm Or, if 1 a e,0 quantity ner tor, l he a good faith effort to ngnlmEza my waste generation and solea the best waste emen ethod that is available <br />tome ca afford. - <br />_ <br />Gusto g ature Dale Driver Si nature Date <br />Print Name Print Drivers Name <br />