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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 652885 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 In (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 / EPA CAD028277036 1-888-6038844 <br /> DATE ONETIMEPICKUP LJ YES or ❑NO <br /> CUSTOMER (� Y'i ��n�'T:=�" RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDE �L) ) <br /> PHONE/%�I� ( S�—/ �CONTACT P pf•J CUSTOMER NUMBER � V�✓ <br /> CUSTOMER EPA# (�f-J L Gf\\U U`L '7/'air/17— AMOUNT <br /> JOB SITE ADDRESS C/J�) r I •'�t—c--._ !//l z..,..� CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> ((AMOUNT) <br /> NOTES: COMMODITY G <br /> HALIDES �� t--� RPM. <br /> r•NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXEO OILS)STATE CODE 221 <br /> NO PLACARDS REQUIRED' <br /> C NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> •NO PLACARDS OR MARKINGS REQUIRED' NEE/7,SERVICE DATE <br /> E] OTHER / PRUMS DRUM SIZE / <br /> MANIFEST NO. C �If /'/'� a / el NO.OF GALLONS <br /> DRIVER TRUCK_.IvJ� 'j TRUCK N0.8 HT. <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,OA 95502•CALOD0161743.(510)476.1740 <br /> ❑ BAYSIDE OIL It,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831)4273773 <br /> ❑ EVERGREEN ENV..4139 N. Valentine Ave. .Fresno,CA 93722.CAD982446882.(510)7954400 <br /> P:�.DEMENNO/KERDOON •2000 N,Alameda Street•Compton.CA 90222•CAT080013352•(310)537-7100 <br /> 0 DIK DIXON•7300 Chevron Way.Dixon,CA 95620.CAT080012602•(707)6935008 <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•CAL000627844 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARERECYCThis is to cerlily that the above named articles are properly classified.describe(.packaged,marked <br /> LARGES R C OUR SISTER COMPANY D WESTERN UNITED ST THE and labeled,and are in proper condition for transportation,according to the applicable regulations o1 <br /> LARGEST flECVCLEfl OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. ,e <br /> �- <br /> 'I HEREBY CERTIFY THAT 1 HAVE NOT MIXED THIS WASTE WITH ANY — —' w.•^^•-"'^`'+-- .,,,,, / v <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY RC.B'S.. CUSTOMER SIGNATURE DATE <br /> •1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />