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FORM NO.AES003 ----_— <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES NO. N 734838 <br /> 1300 S. SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 n (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY <br /> 800-727-2879 888-603-8844 800-73CHICO <br /> 3-9043 <br /> DATE <br /> ONETIME PICK UP OYESor ❑NO <br /> CUSTOMER <br /> RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS <br /> CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT <br /> CUSTOMER NUMBER <br /> CUSTOMER EPA If <br /> AMOUNT <br /> JOB SITE ADDRESS <br /> CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS <br /> CASH RECEIVED <br /> NOTES: AMOU" <br /> COMMODITY <br /> HALIDES PPM. <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 <br /> *NO PLACARDS OR MARKINGS REQUIRED• NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. <br /> NO.OF GALLONS <br /> DRIVER TRUCK NO.8 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 II,LLC•1618 W.5th St.,Chico,CA 95928•CA0980694103•(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•CALOOD282598•(661)377-0308 <br /> ❑ DM 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.•Patter,CA 93648•CAL000102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> RECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE This is to certify that the above named articles are properly classified,described.packaged,marked <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled,and are in proper wndkion for transportation,according to the applicable regulations of <br /> 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 MIE <br /> 9 FURTHER AGREE TO ACCEPT-THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY ROSS. PRINT NAME <br />