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FARM NO,AE5003 <br /> SERVICE ORDER <br /> NO. N 652955 <br /> ASBURY ENVIRONMENTAL. SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA C AD028277036 1-888--603-8844 <br /> DATE Y ` ? ONETIME PICK UP ❑YES 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 .�F CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# r'"�. - - -? AMOUNT <br /> s <br /> JOB SITE ADDRESS CHECK NUMBER <br /> ,•. 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 OIIJMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> Cl: 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. C" rY: 5' NO.OF GALLONS <br /> r <br /> DRIVER TRUCK NO.&RT. r <br /> D NONHAZARDOUS 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 11,INC.•210 Encinal Street•Santa Cruz, CA 95060•CAD086838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV..4139 N_ Valentine Ave. • Fresno, CA 93722.CAD982446882. (510)795-4400 <br /> Dy--DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222 CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON a 7300 Chevron Way o Dixon,CA 95620 e CAT080012602.(707)693-6008 <br /> D 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 /> IECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certify that-the above named articles are properly classified,described, packaged, marked <br /> ARGEST 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 /> STHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X - <br /> rND THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE' DATE <br /> 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 /> ONTAINS ANY P.C.B'S. PRINT NAME <br />