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Sep-22-10 10:54 From-OK Dixon/AES 17076782339 _ T-046 P.007/013 F-094 <br /> / SERVICE ORDEF <br /> No. N 635127 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE C COMPTON.CALIFORNIA 90221 O (310)886-3400 - <br /> DIXON _ <br /> T,BOD-727-2879 EPA CAO02B277036 UNION UNIONeB44 CITY.• <br /> DATE L �/1 . <br /> ONETIME PICK-fW .:'' ' �OYE6 a'p N0 <br /> CUSTOMER 7-, ✓� � �l//��� RESIDENCE0 YES or O NO <br /> BILLING ADDRESS a?r_/ _ L.. 2• Si+r.•r _-i CDNTRACT;CUSfOMER-M-Ill r❑-NO` <br /> PLEASE-PAY:FROMTHIS <br /> SERVICE�.ORDER <br /> PHONE 2- 2)2 �7_c 7 r'rr' CONTACT Com!'•—`� CUSTOMER NUMBER <br /> CUSTOMER EPA q <br /> JOB SITE ADDRESS <br /> r.CHECI(NUMBI=R <br /> , <br /> .:.:PO.NUMBER+. <br /> CROSS STREETS "`CASH RECEIVL� <br /> (AMOUNT) <br /> NOTES: COMMODITY [ <br /> HALIDES P.P.M. <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> •NO PLACARDS REQUIRED, <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> .'NO PLACARDS OR MARKINGS REOUIRED• NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. _ /� ��/"t G �� 1 3 IC` N91 OF GALLONS 2 S , <br /> DRIVER _ / '�TRUCK NO.B HT .5 c, <br /> O NON HAZARDOUS DRAINED USED OIL FILTER_ - <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA.510-487-8277 <br /> O ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502-CALOW161743•(510)476.1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street-Santa Cruz,CA 9506D•CADO881138222-(831)427.3773 <br /> ❑ EVERGREEN ENV..4139 N. Valentine Ave..Fresno,CA 93722.CA0982446882.(510) 795-4400 <br /> ��EMENNO/KERDOON •2000 N.Alameda Street-Compton,CA 90222•CATOBD013352-(310)537-7100 <br /> O PIK DIXON.7300 Chevron Way-Dixon,CA 85620•CAT080012602.(707)693.6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road •W.Sacramento,CA 95691.CAD044003556 .(91e)371.5747 <br /> ❑ ASSURYENVIRONMENTALSERVICFS-2649_SCOOAvenue-Chlco.CA95928-CAL000827844' <br /> C ALTERNATE FACILITY <br /> ISED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE Thla Islpc"tty teal the eboyq names articles om properly classified, descdbo0,packaged,mantes <br /> ,ECYCLED AT OUR SISTER COMPANY OEMENNO/KEROOON THE .eM labeNid,and.a.in �(qq/rnnaitlon fa nepor®tion,eccmdln9 M the applicable reguletlms of <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. Ihs Depertrtwm oTTM mne anon. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> THEP WASTE.THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br /> NO THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. - cU MER 61 UHE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> :INTAINS ANY P.C.S'S, - PRINT MAW <br /> 9'd 8ZLL-6£Z-60Z 3PUES USA A06EIJO 1309:60 Ol 40 100 <br />