Laserfiche WebLink
FORM NO.AES003 <br /> SERVICE ORDER <br /> n asc �s <br /> No. N 576319 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ET COMPTON,CALIFORNIA 90221 D (310)886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 /EEPPA�CA0028277036 1-800727-2879 <br /> DATE �� " / ONE TIME PICK UP ED YES or 11 NO <br /> CUSTOMER5n,--/a��?' S RESIDENCE ❑ YES or J NO <br /> BILLING ADDRESS / 9 ,1Y Az( � T74 CONTRACT CUSTOMER 7) YES or ❑ NO <br /> Ile,fin PLEASE PAY FROM THIS <br /> �I <br /> J ---- - SERVICE ORDER <br /> PHONE./0! 7 U v CONTACT� L�_r CUSTOMER NUMBER <br /> CUSTOMEREPAA _ _ _ !' I-�CJfJ 7Ly AMOUNT_ <br /> JOB SITE ADDRESS f(CHECK NUMBER �' <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> AMD <br /> NOTES: tj�� `r COMMODITY C---✓ <br /> r <br /> HALIDES C�> P.P.M. <br /> N-RCRA HAZARDOUS WASTE.LIQUID(USED O14MIXED OILS)STATE CODE 221_. .. <br /> "ANO PLACARDS REQUIRED' <br /> ❑' NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> NO PLACARDS OR MARKINGS REQUIRED' NEXT SERVICE DATE ' <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. �l ri NO.OF GALLONS ': Gp�_ <br /> DRIVER i C!7 /? TRUCK N0.8 FIT. S ,< <br /> NON HAZARDOUS DRAINED USED OIL FILTER <br /> El COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA, 510-487-9277 <br /> ALTERNATE FACILITY <br /> DESIGNATED TSDF: ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743•(51D)476-1740 <br /> BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95080•CAD088838222•(408)427-3778 i <br /> FI EVERGREEN ENV. .4139 N.Valentine Ave..Fresno,CA 93722.(510)795.4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street-Compton,CA 90222•CAT080013352•(310)537-7100 <br /> b/K DIXON.73DO Chevron Way-Dixon,CA 956'20.CATOBOD12602.(707')693-6008 <br /> G RAMOS ENVIRONMENTAL•1315 S.River Road .W.Sacramenlo,CA 95691.CAD044DD3556 .(916)371-5747 <br /> ASSURY ENVIRONMENTAL SERVICES-2549 Scott Avenue•ChICD,CA 95926•CAL000827844 <br /> I L2 ALTERNATE FACILITY _ <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE Thfs Is 10 rert�y n,ai the above nameo artxles are property dassiCetl,described,packaged marked <br /> RECYCLED C aVR SISTER COMPANY D WESTERN UNITED <br /> THE and labeled,and are in prep&condition for]rens nnal»n,accord 10 the a <br /> LARGEST RECYCLES!OF USED OIL IN THE WESTERN UNrtEp STATES. p P P 0 PP.'rahls rag�laUons of <br /> the Depertm�nt of Transportation <br /> 9 HEREBY CERTIFY THAT i HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE.THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM, X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY PC.9'S.. IWSMMER SIGNATUREfff---- p,1TE <br /> •1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL 1 <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PRM.TOTAL HALIDES, OR X 3- ' f <br /> CONTAINS ANY PC.BS. PRINT NAME <br />