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FORM NO.AES003 <br /> SERVICE ORDER <br /> .= ..' - NO. N <br /> 62955 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310)g86-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE ONETIME PICK UP ❑YES or ❑NO <br /> _.:� - i r" � ' ... - <br /> CUSTOMER `i,.;7 RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE jet' ¢ - CONTACT _ CUSTOMER NUMBER <br /> r... AMOUNT <br /> CUSTOMER EPA# ,�* � - , r J f' <br /> - a- <br /> JOB SITE ADDRESS CHECK NUMBER <br /> RO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY/ ,.J r .`'1 .,:7 <br /> HALIDES RPM. <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 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS `' 'S <br /> DRIVER /}. TRUCK NO.&HT. cn, <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> 0 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•{510)476-1740 <br /> ❑ SAYSIDE OIL It,INC.•210 Encinal Street•Santa Cruz,CA 95460•CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave. • Fresno, CA 93722•CA0982446882. (510)795-4400 <br /> 4;--DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> `❑ DIK DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.RWPj Road .W.Sacramento,CA 95691 *CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <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 AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, the Department cf Transportation." t r <br /> y <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXE=D THIS WASTE WITH ANY r" <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM.; X .rte }��v � 'T �f <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOfdER,BIC,NATU DATE <br /> *1 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 P.C.B°S. PRINT NAME <br />