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FORM NO.AES003 <br /> ..J SERVICE ORDER <br /> No. N 635272 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310)886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE_ / ONETIME PICKUP EI YES or ❑NO <br /> CUSTOMER C/� �I / //.lrl—r, �y�Hi"'-�'ems✓ RESIDENCE ❑YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> y SERVICE ORDER <br /> PHONE6 !� (73 c�••- y�� CONTACT 4�,i CUSTOMER NUMBER <br /> CUSTOMER EPA# C / AMOUNT <br /> 7 <br /> JOB SITE ADDRESS �oI rd CHECK NUMBER <br /> j '%) `6 P.O.NUMBER <br /> CROSS STREETS - °T CASH RECEIV90 <br /> .. (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES �/a n P.P.M. <br /> S),NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED 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 REQUIRED` NEX SERVICE DATE % <br /> ❑ OTHER D MS's DRUM SIZE <br /> MANIFEST NO. C7�7 o Y7?e1�► c NO.'OF GALLONS e!590 O <br /> DRIVER TRUCK NO.&RT <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <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 /> C1BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD068836222•(831)427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. .Fresno,CA 93722.CAD982446882.(510)795-4400 <br /> 64dEMENNO/KERDOON•2000 N.Alameda Street•Compton.CA 90222•CAT080013352•(310)537-7100 <br /> n DIK DIXON.7300 Chevron Way.Dixon,CA 95620•CAT080012602.(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CAD044003556 .(916)371.5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 i <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to mlity that the above narred articles are property classified,described,packaged,marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE arM lab and are in proper mn tion for transportation,acmrding to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the D ar enl of Transportation. <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY ,.a I <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X r91n. �lL� 7 G D <br /> AND THAT TME WASTE GOES NOT CONTAIN ANY P.C.e'S.. �/ C OMER SIGNATURE DATE <br /> •I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL � II ` <br /> DISPOSAL IF THIS WASTE IS OVER 10.00 P.P.M.TOTAL HALIDES, OR X j2-f/h. 76c, -c. 1r�_`e/ <br /> l(:�•- <br /> CONTAINS ANY P.C.B'S. PRINTNAME <br />