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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFj CE <br /> 1-800-7-A SE URY _ SERVICE ORDER NO. <br /> UNION C1OFFICE = = I <br /> 1-888.603-8 41' <br /> ICO OFF CE <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 13,00 SOUTH SANTA FE COMPTON CA 90221 <br /> s +,.310.886-3400 <br /> la TRANSPORTER EPA 0 CA0028277036 <br /> p <br /> Ll <br /> T <br /> 0 <br /> CIUSTOME R z PURCHASE ORDER ROUTE;$ TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQ IRED GATE ENTERED NEXT SERVICE DATE CUSTOMER EPA 9 MANIFEST tt <br /> PART;; DESCRIPTION QTY UNIT PRICE CITY P;U TOTAL <br /> I <br /> TOTAL <br /> .SH REC' : CHECK 9 PLEASE PAY FROM THIS SERVICE ORDER <br /> WASTE DISPOSAL INFORMATION <br /> NON. CRA HAZARDOUS WASTE, LIQUID(USED 0ILIMIXED OILS)-NO PLACARDS REQUIRED' STATE CODE 221 <br /> NOW CRA HAZARDOUS WASTE.LIQUID(ETHYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIRED- STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF: <br /> ALTEF NATE TSDF: <br /> SA RECYCLING: 33210 Western Avenue, Union City,CA 94587 1-514-487-9277 <br /> DRUMS P EMPTY DRUMS: FACILITY BSC <br /> GENERATOR WASTE CERTIFICATION <br /> PLEASE CHECK THE APPROPRIATE 80X <br /> This.s to cemry Inat the waste descnbed above is properly classilied,dounbod.pacraged.marbled anti labeled,a,.t proper condmon for transportationattording to aPpllcawe Slate <br /> and federal togulaticins ev stgwng b.+uw I also hstebw ce+tdy it-at <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> A All)I have normaed arty of the waste described abu.e with any opter hazardous waste,me total hands convent.s LESS than 1,000 ppm,and the,wattle does not contain any VCes 1 have <br /> tompl,ed_1h Ile ttigtarementtt o1 the applicable Caa hfonaused chi management regulations to dustmen•11,I&Is true I agree to accept in$eWdt/Ional charges for the disposal of this waste <br /> ,f the tnbrm.tr 1 I have provided about this waste t•.ncorrecl <br /> have Hart m.a.d anY of the.rate drsr-n bad a6av•+wish any ether natereaw•wwsM,eh.toed hat.da c..nl e,n •Gee[ATCN tM�I,OtM pPm,and rhe..rN•do•s not cansa.n any NC Bs 1 <br /> lta,.a provided open dot.mentation to Asou,y Environmental Services to rebus the pree.dnption that th.s aate was—.ad wtth other hazardous waste I agree to accept the additional charges <br /> IOt the disposal of this waste.1 Ina+nformeticn 1 have plov.ded Abort 111#4 wool#It.nctsrfact <br /> ell Th.s wr*I .•Prom a nn+which cottecto wosle o.t Yrear.fou»Hold"do+ayeursuP IDtYI Ondt or cnndhonuly e■ampl*mail quantity gensrsiof tCESQGI axnces Toth*best of my <br /> snowtodge.the my wash od contained In my DIY,'CESOG eollectloo lanA Is coley from DIY and'or CESOG sources I have not mixed th.a waste od.tm any other hasardous waste o, <br /> .Oslo oil from het aato ves.I+gree to scropr the oddlnonal charges for 3aposal of Ih.e weave H the mformahon I he's provtded about"me vrasle it Intoned <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> S y)If l an a I irge quantify gennalw,1 corIIfy that I have a prugraru to place to reduce tl+a volume and tosocoty 41 wasle vaneraled to Ina do}r r+I ase.• 3otsrmrnea to be sconorn.catty <br /> "oanCeble and that 1 here 1411W100 me pracoc Atae method of uItatntent,sto,age ut 04poral cul envy ovltlable to nH which nOn.nual•use We—II mvJ tutu#■It It set to I'uPIWI nae dad <br /> onvironmen,ot,1f I am a%moll quantity gem►talor_I have made a good faith•nWt t0 mommas my waste generation and select the best waste management method that is vallatxa <br /> ,ne#hal I can ord <br /> CustomerSignature Date Driver Signature Date <br /> Print Name Print Drivers Name } <br />