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Sep 22-10 0:53 From-DK Dixon/AES — 17OT6782339 T-046 P 002/013 F-094 <br /> SERVICE ORDER <br /> a <br /> . No. N 639540 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE 0 COMPTON.CALIFORNIA 90221 O (3101866-3400 <br /> DIXON UNION CITY <br /> 1-800.727-2879 EPACAD028277036 1-888-603.8844 <br /> DATE ONETIME PICKUP AYES or ONO <br /> CUSTOMER ��i� �'l-* -���'� RESIDENCE ❑ YESor 0 NO <br /> BILLING ADDRESS CONTRACT CUSTOMER Q YES of ❑ NO <br /> PLEASE PAY FROM THIS <br /> 7SERVICE ORDER <br /> PHONEY ,� ! S �7' 3 STT CONTACT -�- nl CUSTOMER NUMBER <br /> CUSTOMER EPA 0 r �� e&"zeE Y J/ AMOUNT <br /> JOB SITE ADDRESS _ �l i�/ ' /' s CHECK NUMRER <br /> f7T�I J-Yr-�.0 J 'I?76'1 P,O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMC0" <br /> NOTES: COMMODITY f <br /> HALIDES <br /> UVNON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)STATE CODE <br /> 'NO PLACARDS REQUIRED* <br /> 1:_:: is ... <br /> ❑ NDN-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE'CODE1 <br /> 'NO PLACARDS OR MARKINGS REQUIRED' ' ' N EFMCE DME <br /> ED OTHER UMS DRUM SIZE <br /> MANIFEST N0. i AJ X42 ,.J NO.OF GALLONS <br /> DRIVER /iA� TRUCK NO.8 RT. = C� <br /> i <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Westem Avenue,Union City,CA,SA-487-9277 <br /> ❑ ALTERNATE FACILfTY <br /> DESIGNATEO TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Sneer,•Alvlso,CA 85502•CAL000161743.(5101 475-1710 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•SenTa.Cruz,CA 95060•CAD0311838222•(1531)427 3773 <br /> ❑ EVERGREEN ENV..4139 N. Valentine Ave. •Fresno,CA 93722. CAD902446887•(510)795.4400 <br /> 1* DEAAENNO/KERDOON•2000 N.AlamSda Street•Compton,CA 90222•CATOEU013352•(310)537-7100 <br /> 'Q D/K DIXON.7300 Chevron Way.Dixon,CA 9562D.CATO80012602.(707)883.6008 <br /> 0 RAMOS ENVIRONMENTAL• 1516 S.River Road .W.Sacramento,CA 95891•CADO44003556 .(916)371-5747 <br /> 7 ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Cnico,CA95928•CALDDOB27844 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE Th19 19 to C"ify that Iho ahoaa nama4 an:Wua are PrOPS11Y cla6alf•e0.d0!$cn e0,pecks 0, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNDIKEROOON THE emf IafM1e0,and wa M proper ,carxllean for Vaneportetwn,ll 0 il1g Io the appli—tM-'egWafiorw of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. ^the r P.n :afTrcnspa wc.m / <br /> 9 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1050 PPM; X /'f ✓L""�`✓ ��-/ ,/ <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. GU51OM RSIGNATURE <br /> •1 FURTHER AGREE TO ACCEPT TME ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1005 P.P.M.TOTAL HALIDES, OR PRINT NAME <br /> CONTAINS ANY P.C.0'8. <br /> ll'd 87LL-6EZ-60Z 1PLIBS USA /dO6ea0 ecg:60 OL b0 100 <br />