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FOR SERVICE CALL: SERVICE ORDER VORM O ACS004-BWEV1G.'07) OIXON OFFICE 1-800-7-ASBURY _ SERVICE ORDER NO. UNION CITY OFFICE 1-888-603.8844 - _ = N1574756 CHICO OFFICE 800-733-9043 ASBURY ENVIRONMENTAL SERVICES 1300 SOUTH SANTA FE,COMPTON,CA 90221 P 1-314-8e6-3 TRACY SHELL CA i TRANSPORTER EPA#CAD028277436 RADC ENTERPRISES P 3725 N. TRACY BLVD L 1040 N. BENSON AVE 0 T TRACY, CA 95304 UPLAND, CA 91786 0 (209) 835 7608 (209) 835.7608 ; CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES ( ( TRA113 94 STEVE H Lakeia DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# \ 2/1212013 2/11/2013 CAL000358973 d I03-� WO`-)J �(�` PART# DESCRIPTION QTY UNIT PRICE QTY PIU TOTAL 30-OfTM 30 GALLON O/T METAL DRUM 1 $61.00 $66.03 OILY SO OILY SOLIDS PER DRUM 1 $185.00 2 .69 i OW 0K1 0339 EXOP 4/29112 DK DIXON f Crpss Streets: TOTAL CASHREC'D: CHECK tit PLEASE PAY FROM THIS SERVICE ORDER WASTE DISPOSAL INFORMATION NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)"NO PLACARDS REQUIRED` STATE CODE 221 NON-RC HAZA O S ASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED' STATE CODE OTHER:) I W <Y� �S DESIGNATED T DFfL O >zl �(. 11'•; f }i 1 ALTERNATE TSDF: SA RECYCLING: 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 1 t, 1••� FIT DRUMS PIU:—_ EMPTY DRUMS: FACILITY:S[L—BSC GENERATOR WASTE CERTIFICATION PLEASE CHECK THE APPROPRIATE BOX 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 Slate and federal regulations.By siqnfng below I also hereby certify that: (Waste oil generator/customer MUST check ONE of the following three boxes) U 41)I have not mixed any of the waste described above wllh any other hazardous waste,tho total halide content Is LESS than 1,000 ppm,and ilia waste does not contain any PCBs.I have complied with the requirements of the applicable California used oil management regulations to dotermine this Is true.I agree to accept the additional charges for the disposal of this waste If the Information I have provided about this wade is Incorrect n#2)1 kava not mixed any of the waste descrlbed 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 docurrtontalion to Asbury Environmental Services to rebut the presumption that this waste was mixed with other hazardous waslo.I agree to accept the additional charges for the disposal of this waste if the information I have provided about this waste Is incorrect p 43)This waste is from a tank which collects waste oil from household"dodt•you(selr'(D)Y)andfor conditionally exempt small quantity generator(CESQG)sources.To the best of my knowledge,the only waste oll contained In my DIY!CESQG collection lank Is soloy from DIY andlor CESQG sources.I have not mixed tills waste oil with any other hazardous waste or waste oil from other sources.I agree to accept the additional chargee for disposal of thlswasle If the information I have provided about this waste Is Incorrect (All generators/customers MUST read the following text and check the associated box.) n X4) If I am a targe quantity generator,I cerlify that I have a program In place to reduce the volume and toxicity o1 waste generated to Ilio degrea I have determined to he economically practicable and that I have selected the practicable method of treatment,storage,or dispose currently available to me which minimlens the present and future threat to human life and the environment;Or,If I am a small quantity generator,I have made a good faith elfccc+�ttt to rrtin�n'#�my waste generation and select the best waste management method that Is available 4thatafford. Y (V�` v /�ignature Date Driver Signature Date (� Date �- 0.;rf n.;.,— f+t-