Laserfiche WebLink
FORM NO.AES003 <br /> i SERVICE ORDER <br /> No. N 6390 <br /> ,92 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FF AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE %' - 'r ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER r f "' RESIDENCE ED YES or E2 NO <br /> s` <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT_ ! CUSTOMER NUMBER <br /> CUSTOMER EPA .e�e_� T/il z AMOUNT <br /> JOB SITE ADDRESS S C Al,r��j - CHECK NUMBER <br /> `� w-- P' P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY , <br /> HALIDES ~ � ' P.P.M. <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. r'% "i a�J ZC' NO,OF GALLONS <br /> DRIVER ``' ' TRUCK NO.&HT. <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,CA 95502•CAL000161743.(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave • Fresno, CA 93722•CAD982446882. (510)795-4400 <br /> DEMENNO/KERDOON -2000 N.Alameda Street•Campton,CA 90222•CAT080013352•(310)537.7100 <br /> ET D/K DIXON.7300 Chevron Way a Dixon,CA 95620.CAT080012602•(707)693-8008 <br /> RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> ECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certify that the above named articles are properly classified,described, packaged, marked <br /> and labeled,an in proper con, <br /> S. iransportatior�, according to the applicable regu{ations of <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, the Dopartmen��T nsportation./ s <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY j r ' <br /> THER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X �.f ' ' 14_ <br /> ND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. USTOMER SIG y4TURE PATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> 0NTAINS ANY PC.B'S. PRINT NAME <br />