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FARM NO.AES003 <br /> SERVICE ORDER <br /> - - NO. N 652763 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-80727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE <br /> ONETIME PICK UP E]YES or ❑NO <br /> CUSTOMER i <br /> d <br /> RESIDENCE -1 YES or :1 NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or D NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE F CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS r '` f CHECK NUMBER <br /> r - [ P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> ,,(AMOUNT) <br /> NOTES: al <br /> f> <br /> COMMODITY <br /> HALIDES PPM. <br /> ted- 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 �✓r� <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; Cl ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,0A 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 /> 7 -DEMENNO/KERDOON •2000 N.Alameda Street•Campton,CA 90222•CATOSOO13352•(310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way a Dixon,CA 95620 o CAT080012602•(707)693-6008 <br /> ❑ RAM OS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CA0044003556 .(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 This is to cern that the above named articles are properly classified, described, packaged, marked <br /> ECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE P R Y <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled, and are in proper Condit#on 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 /> THER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.; X <br /> ND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE ATa <br /> HER <br /> AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, Ofd <br /> ONTAINS ANY P.C.B'S. PRINT NAME <br />