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FORM NO.AES003 <br /> '=- SERVICE ORDER <br /> _— No. N 748196 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310)856-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO <br /> 800-727-2879 888-603-8844 800-733-9043 <br /> DATE ONETIME PICK UP OYES or O NO <br /> CUSTOMER RESIDENCE ❑ YES or O NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or O NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED _ <br /> (AMOUNT) _ <br /> NOTES: COMMODITY <br /> HALIDES P P NI <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIOUID(USED OIL/MIXED 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 SIZE <br /> MANIFEST NO. NO.OF GALLONS <' <br /> DRIVER TRUCK NO.&RT. <br /> ❑ 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 If.LLC•1618 W.5m St.,Chico,CA 95928•CAD980694103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•2DO Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•(800)733-9043 <br /> O BAKERSFIELD TRANSFER INC. •1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ D/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 /> ❑ SAN JOAQUIN FILTER RECYCLING•14287 E.Manning Ave.•Padier,CA 93648•CAL000102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This Is to certify that the above named snipes are properly passilietl,descnbed,packaged, marked <br /> RECYCLED C OUR SISTER COMPANY D WESTERN <br /> UNITED ST THE and labeled,and are in proper condition for transportation,according to the applicable reUulatwns or <br /> LARGEST RECYCLES!OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <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.. CUSTOMER SIGNATURE DATE <br /> - <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />