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---- - - - � - -. FORM NO.AE5003 - <br /> _ - SERVICE ORDER <br /> - No. N 903347 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 o (310)886-3400 c <br /> EPA1f CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> w <br /> DATE f ONE TIME PICK UP F]ES or F1NO <br /> CUSTOMER.Uh! RESIDENCE ❑ YES or ❑ NO <br /> BILLING.ADDRESS CONTRACT CUSTOMERES or ElNO <br /> PLEASE PAY FROTHIS <br /> SERVICE ORDER. <br /> PHONE 24 q y Z � �CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA ffiC-__,4j_ j ��� �� AMOUNT <br /> JOB SITE ADDRESS 5�) CHECK NUMBER <br /> PO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> n (Ab10U" <br /> NOTES: COMMODITY��J <br /> HALIDES RPM. <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)STATE CODE 221 <br /> 'NO PLACARDS REQUIRED' <br /> `❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> 'NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM <br /> SIZE <br /> MANIFEST NO. (�/ NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. 2, <br /> O USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO 11,LLC•1618W.5th St.,Chico,CA 95928•CAD980694103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. •1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> /K DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL•1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑ WORLD OIL-SAN JOAOUIN,LLC•14287 E.Manning Ave.•Parlier,CA 93648•CAL000102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify t the above named articles are properly classified,described,packaged,marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, i opercID ion for lransportahon,aceo7iiing to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, the abet to qsp lahon <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.; X �7 6E7 <br /> ANDTHAT THE WOSTE DOES NOT CONTAIN ANY P.C.B'S.. CTo tuAE —! <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL 1'� <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> CONTAINSAN� P.C.ITS. PRINT NAME <br />