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IORM NO.ALSW3 <br /> a-� SERVICE ORDER <br /> No. N 764 315 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE ONETIME PICK UP . DYES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILUNGADDRESS CONTRACT CUSTOMER ❑YES or ❑ 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 /> HAUDES PP.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED• <br /> ❑ NON-RCRA HAZARDOUS WASTE,UQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> 'NO PLACARDS OR MARKINGS REQUIRED' NEXT SERVICE DATE <br /> ❑ OTHER -y DRUMS DRUM SIZE <br /> MANIFEST NO. 'J ( - NO.OF GALLONS <br /> 3 <br /> DRIVER TRUCK NO.B 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 11,LLC•1618 W.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•CALOD0282598•(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 /> ❑ WORLD OIL-SAN JOAQUIN,LLC•14287 E.Manning Ave.•Parker,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 articles are properly classified,described,packaged,marked <br /> RECYCLED C OUR SISTER COMPANY DEM TERN UNITED <br /> ST THE and labeled,and are in proper condition for transportation.according to the applicable regulations of <br /> Department OI Transportation. <br /> •I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY , v <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.: X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.e'S., C99TOMER SIGNATURE MTE <br /> M FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PRM.TOTAL HALIDES, OR <br /> CONTAINS ANY PC 8S. PRINT NAME <br />