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FORM NO.AES003 <br /> SERVICE ORDER <br /> NO. N 636985 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 Cl (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-868-603-8844 <br /> DATE / O ONETIME PICK UP 173 YES Or ❑NO < <br /> CUSTOMER r ,J - RESIDENCE ❑ YES or 11NO <br /> CONTRACT CUSTOMER ❑ YES Or ❑ NO <br /> BILLING ADDRESS <br /> PLEASE PAY FROM THIS <br /> \{� SERVICE ORDER <br /> PHONE '���� �' CONTACUSTOMER NUMBER <br /> CUSTOMER EPA# 17.% 7 G AMOUNT <br /> JOB SITE ADDRESS "'" ��+'rt CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED y.MouNT) <br /> COMMODITY <br /> NOTES: �^ <br /> HALIDES P.P.M. <br /> NON-RCRA HAZARDOUS WASTE.LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> i *NO PLACARDS REQUIRED* , <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 �l <br /> *NO PLACARDS OR MARKINGS REQUIRED" NEXT <br /> //S,LRVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> NO.OF GALLONS 30 CC3 <br /> MANIFEST NO. <br /> DRIVER <br /> TRUCK NO.8 RT <br /> G :� <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER J <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510.487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831)427-3773 <br /> ❑ EVERGREEN ENV. •4139 N. Valentine Ave. • Fresno, CA 93722•CAD982446882• (510)795-4400 <br /> EMENNO/KERDOON •2000 N.Alameda Street•Compton.CA 90222•CAT080013352•(310)537-7100 <br /> _1 D/K DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CA0044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified,described,packaged,marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON 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 Deparap@`nI of Transportation. ry <br /> •i HEREBY CERTIFY THAT I HAVE NOT MIXED Tell <br /> HIS WASTE WITH ANY Ys ,y// t� 7-/�� /L% ^'�'� �y-y '; <br /> OTHER WASTE.THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM,; X ///���kkk(�/+ '" / �+ l <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CVSTOMER SIGNATURE ATE <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 ggINT NAME <br /> CONTAINS ANY P.C.B'S. <br /> Zi, d 8ZLL-6£Z-60Z 3PUBS Den fUO69JO ey9:60 Ol 40 300 <br />