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FORM NO.AES003 <br /> SERVICE ORDER <br /> NO. N 639250 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE 0 COMPTON, CALIFORNIA 9022) 0 (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE � s` <br /> ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> } SERVICE ORDER <br /> PHONE . ��j r CONTACT +` ^� <br /> CUSTOMER NUMBER <br /> CUSTOMER EPA# r ,r�+ `k AMOUNT <br /> JOB SITE ADDRESS 5 ,. r,- CHECK NUMBER <br /> NUMBER <br /> CROSS STREETS CASH RECEIV_E6 <br /> (AMOUNT) <br /> NOTES: COMRQ6TY Z,//-- <br /> ,;-HALIDES-, '� -" C% PP'M' <br /> ❑' NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLEN&GLYCOUSOL-litONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑. OTHER DRUMS DRUM 512E <br /> MANIFEST NO. NO.OF GALLONS 4a3 <br /> DRIVER TRUCK NO.& RT ' <br /> ..❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ 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,GA 95502•CAL000161743• 510 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV.•4139 N_ Valentine Aye. •Fresno, CA 93722•CAD982446882 .(510)795-4400 <br /> CEMENNC3/KiERDOON •2000 N.Alamey aa&reet•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ D1K DIXON•7300 Chevron Way*D'aon CA 956201.CAT080012602•(707)69376008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River(toad .W Sacramento,CA 95691.CAD04400 56 .(91 -371 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL00o B44 - i <br /> ❑ ALTERNATE FACILITY- <br /> USED OIL,USED ANTIFREEZE AND OPLY WATER WASTE STREAMS ARE This is to certify that the shove named articles are properly classified,.described, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMfNNO1KERDOON 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 of Trarm dn. <br /> *l 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 THATTHE WASTE DOES NOT CONTAIN ANY R.C.B'S.. CUSTOMER SIGNATURE DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALfDES, OR X ". <br /> CONTAINS ANY P.C.B'S.. PRINT NAME <br />