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I <br /> �... FORM NO.AES003 <br /> SERVICE ORDER <br /> M1 a- <br /> No. N 639445 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 O (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800.727-2879 - EPACAD028277036 1-888-603-8844 <br /> DATE ONETIME PICK UP ❑YES or ❑NO <br /> jCUSTOMER Q Il/�/� � ��r' RESIDENCE ❑ YES or ❑ NO <br /> i BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> r y�� C SERVICE ORDER <br /> J <br /> PHONE //CJS,) J'— � � CONTACT i CUSTOMER NUMBER <br /> CUSTOMER EPA N O '7 AMOUNT _ <br /> JOB SITE ADDRESS CHECK NUMBER <br /> C `52T l/�/I �! -t P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> MWNIT) <br /> NOTES: COMMODITY <br /> HALIDES ��rldO P.P.M. <br /> 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" /NEXSERVICE DATE <br /> O OTHER - DRUM SIZE <br /> MANIFEST NO. �(')� 'S�O� �1�1C' NO,OF GALLONS aO^�O <br /> DRIVER TRUCK NO.&HL------=a--�= I- <br /> O NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> O 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•Sama Cruz,CA 95060•CA0088838222•(831)4273773 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave. .Fresno, CA 93722.CA0982446882.(510)795-4400 <br /> DEMENNO/KERDOON .2000 N.Alameda Street•Compton,CA 90222-CAT080013352•(310)537-7100 <br /> 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 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE / <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is erlity 11 a Ana ed arlic are pro ly'Gassilieq tlescribeq parkagetl,marked <br /> LARGEST RECVCLER OF USED OIL IN THE WESTERN UNITED STATES. and lab ,antl pr r n tllllon f rans ion,according to the applicable regulations of <br /> the D arlmenf I ne li , c <br /> •I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; :X / <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. / _ } STOME SroNATORE DATE <br /> FURTHER L CHARGES FOR LEGALVI <br /> DISPOSALIFGHIS WASTE IREE TO S OVE 1000 PPTHE AM TOTAL HALIDES, OR X..�Y�C. �✓`_ f� 1- � (�r'">/,\� <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />