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FORM NO.AES003 <br /> • SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES RWF' VED <br /> 1300 S. SANTA FE AVENUE LiCOMPTON, CALIFORNIA 90221 n (310) 8863400 <br /> EPA#CAD028277036 MAY 2 1 2015 <br /> DIXON, UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-693 <br /> 14C QI TIJ nC0110T11C�iT <br /> ONE TIME PICK UP OYES or ❑NO <br /> DATE <br /> RESIDENCE ❑ YESor ❑ NO <br /> CUSTOMER <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER - 1 ' <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED (ANouNn <br /> NOTES: COMMODITY <br /> HALIDES RPM• <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILJMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE NEXT SERVICE DATE <br /> NO PLACARDS OR MARKINGS REQUIRED <br /> DRUMS DRUM SIZE <br /> ❑ OTHER <br /> NO.OF GALLONS <br /> MANIFEST NO. <br /> TRUCK NO.&RT <br /> DRIVER <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: F-1 ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC•1618 W.5th St.,Chico,CA 95928•CAD980694103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. • 1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ D/K DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL•1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC•14287 E.Manning Ave.•Earlier,CA 93648•CAL000102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to cenity that the above named articles are properly classified, descnbed,packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X CUSTOMER SIGNATURE onrE <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. <br /> "1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR pgIryT NAME - <br /> CONTAINS ANY PC B'S <br />