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. FORM NO.AES003 <br /> SERVICE ORDER <br /> NO- N 652966 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE U COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 14800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE � '� ` <br /> ONETIME PICK UP El YES or ❑NO <br /> CUSTOMER r - RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS <br /> CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE r` !~ CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS , .' CHECK NUMBER <br /> PO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES; <br /> COMMODITY ;•' <br /> l . <br /> HALIDES P.P.M, <br /> •❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OiUMIXED 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 <br /> NO.OF GALLONS <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,CA 95502-CAL_000161743-(510)476-1740 <br /> C BAYSIDE OIL 11,INC,-210 Encinal Street-Santa Cruz,CA 95060-CAD068838222-(831)427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave + Fresno, CA 93722.CA0982446882. (510) 795-4400 <br /> EI DEMENNO/KERDOON -2000 N.Alameda Street-Compton.CA 90222-CAT080013352-(310)537-7100 <br /> ❑ D1K DIXON.7300 Chevron Way a Dixon,CA 95620.CAT080012602.(707)693-6008 <br /> RAMOS ENVIRONMENTAL.1515 S.River Road -W.Sacramento,CA 95691-CAD044003556 '(916)371-5747 <br /> 11ASBURY ENVIRONMENTAL SERVICES-2549 Scott Avenue-Chico,CA 95928-CAL000827844 <br /> 17 ALTERNATE FACILITY <br /> ED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to cern that the above named articles are properly classified,described, packaged, marked <br /> CYCLEp AT OUR SISTER COMPANY pEMENNO/KERDOON 7HE � P p y <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled,and are in proper condition for transportation, according to the applicable regulations of <br /> the Department of Transportation. <br />'HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> I"HER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM.; X <br /> VD THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S., CUSTOMER SaGNATURE ! DATE I <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> SPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL. HALIDES, OH <br />]NTAINS ANY P.C.B'S, PRINT NAME <br />