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sestvi <br />DixoN app,c <br />eQ0-7.AssuR y <br />FRESNO <br />59-498-0240 <br />HICO OFF/CE <br />800-7 33-9043 <br />SERVICE ORDER <br />'••-• <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 SOUTH SANTA FE, COMPTON, CA 90221 <br />1-310-886-3400 <br />TRANSPORTER EPA # CA0028277036 <br />FORM NO. AES004.5 II4F1110/0T1 <br />SERVICE ORDER NO. <br /> <br />0 <br />CUSTOMER PURCHASE ORDER ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES <br />DATE REQUIRED <br />NEXT SERVICE DATE CUSTO ER EPA MANIFEST # DATE ENTERED <br />TOTAL <br />PLEASE PAY FROM THIS SERVICE ORDER <br />WASTE DISPOSAL INFORMATION <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED 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 Weste,rn Avenue, Unten City, CA 94587 1-510 -437-9277 , <br />RUMS Pill: EMPTY DRUMS: FACILITY: ESC <br />, <br />ASH REC'D: CHECK <br />PART # <br /> <br />DESCRIPTION QTY 1 UNIT PRICE QTY PIU TOTAL <br />GENERATOR WASTE CERTIFICATION <br />PLEASE CHECK THE APPROPRIATE BOX <br />is is <br />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 />federal regulations. By signing below I also hereby certify that: <br />(Waste oil generator/customer MUST check ONE of the following three boxes <br />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 PCSs.I have <br />rnplied with the requirements of the applicable California used oil management regulations to detei mine this Is true. I agree to accept the additional charges ion the disposal of this waste <br />he information I have provided about this waste is incorrect <br />),I have not mixed any of the waste described above with any other Hazardous waste, the total halide content is GREXI ER than 1,000 ppm, and the waste does:tot contain any PCBs. I <br />provided proper documentation to Asbury Environmental Sim vices to rebut the presumption that this waste was mixed with other hazardous waste. I agree to accept the additional charges <br />disposat of this waste if the information I have provided about this waste is incoirect <br />p)I. <br />ThiS waste is from a tank which collects waste oil from household "dokt-yourselr (DIY) andlor conditionally 0:0100 smell quantity generator ICESQGt sources o the best of my <br />$:yfIedite, the only waste oil contained in my DIY/ CESQG collection tank is soluy from GlY and/ill CESQG sources. I lwve not mixed this waste oil with any other hazardous waste or <br />twoit,from other sources, I agree to accept the additional charges for disposal of this waste if the information I have pi ovided ahout this waste is incorrect <br />(All generators/customers MUST read the following text and check the associated box.) <br />quantity generator, I certify that I have a program in place to reduce ills volume and toxicity of waste generated to the degree I have deteimined to be economlcally <br />I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present ,lnd tutors threat to human lite and <br />If tarn a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management mettiod that he available