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FOR SERVICE CALL: SERVICE ORDER <br /> DIXON OFFICE <br /> 1-8e0-7-R5f3UF?Y = SERVICE ORDER NO. <br /> 5V-1198-0240 = _ <br /> '= <br /> CfHCO OFFiCE -600-133-9043 <br /> ASBURY ENVIRONMENTAL.SERVICES <br /> x 1300 SOUTH SANTA FE, COMP FON,CA 000221 <br /> 1-310-886-3400 <br /> s/ CRANSPOfRTi R EPA#CAD0202770:I6 <br /> ) <br /> CUSTOMEI2# PURCHASE ORDER# ROUTF':# T1 CK# CONTACT NAME ODDER TAKEN L3Y HALIDES <br /> 17ATE f2 QUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# MANIFEST# <br /> OESCRiPTION QTY UNIT pRiCE QTY PIU TOl'Al. <br /> LON. <br /> I OCT 0 6 <br /> 2014 <br /> ENVI�t <br /> �NMEHTAL HEALTH <br /> DE�'ARTM�'NT <br /> --- __ TO <br /> CASK RECD CHECK PLEASE PAY FROM THE SERVICE �3RDl�fi� <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LiQUID(USED OIUMIXED OILS)`NO PLACARDS REQUIRED` STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETMYLENE GLYCOL SOLUTIONS)'NO PLACARDS REQUIREW STATE CODE:; <br /> OTHER: <br /> DESIGNATED TSDF.. _ .•_ _ _ _ <br /> ALTERNATE.TSDF: <br /> SA IR CYCLING: 33210 Western Aveime,Unimi City,CA94.587 1-510-487-8277 <br /> DRUMS PIU: EMPTY DRUMS: FACILITY:_.� BSC <br /> GENERATOR WASTE CERTIFICATION — --- --___ <br /> PLEASE CHECK THE APPROPRIATE BOX <br /> 'I",,s to carofy ilial the waste described above is properly Classified,described,packaged•nrarked and labeled,and is in proper Condition for tranvportation,accorairng to applicable Stalf <br /> .nil ladrraf regufannna.By signing Oobiw I atsu ferehy cerirty 11,41: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> l N))f have not mixed any of the waste described above with any other hazardous waste,the total hatitte content is LESS than 1.000 ppm,and the vaisie does nut contain any PCI)s.I have <br /> nnrphed whb tite requliantel is of 1110 applicable California used oil management rogul:d,ons to dotornune tbia Is hue.1 agree lu accept du:additional Charges for lite disposaf of this Wd5le <br /> vw mtornianwi i have provided abuut this waste is incorrect <br /> i 017)1have not rnt*.url any of Ilia waste described above with any olhkr nataidous waste,the total halida content is CREATEn than t,000 ppm,and tiro Waste does not Contain any Picas.I <br /> ave provided proper documentation to Asbury flivifonatentai Servk.as to robot the liresurnption that mis waste was mixed with other hatardous waste.I aguso 10 accepttho additional charges <br /> it Ina disposal of this waste 11 Cha information 1 have provided ahead this waste is incettect <br /> a])This waste i5 front a lank wh[ch collects waste oil floor household"tin-ibyour Solt'(01v)aodtor couctinwwity oaempt small quantlty gonorator(CG•SOG)sources.To ilia utast or my <br /> rwwiudgo,too oniy waste oil contained in my t)IYh CESOC collection tank is soley from Oly andMr CESOO anurcaa.1 have not nixed thus waste oil with any other hazardous waste of <br /> -,ale off fruit)Ogler source#,I agree to accept the additional charges for disposal of this-este it the udnrntahuri f have provided about this vraste Is incorrect <br /> (All generators/customers MUST reixd the Following text and check the associated box,) <br /> 1141 If i am a large quartlily generator,I ratify that I have a program in place to roduco the volume and toxicity Of waste lieneraled to the dogiee I have detarmined to be econonkalfy <br /> aclirabie and that I have selected file placticallto method of treatment,storage,or disposal currently availahlo to me which minirltitas the present and future threat to human lite and <br /> ,e onvirurnnant;9t.if I am a small quantity generator,t have mail#a good faith effort to irunimite my waste flenei anon and select ore hest waste managarnent method that is avaiiatity <br /> file Thal t can afford. <br /> t 1 <br /> t.tsta)n�i "ifJilaLLII'G ? Date briver Signature Date <br /> hint NahnQ Cr..,r nv:.. ►0« ,_ <br />