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FORM NO.AES003 <br /> SERVICE ORDER <br /> iM - NO. N 652613 <br /> f <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE a COMPTON, CALIFORNIA 90221 D (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE , <br /> 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 r 43;-y T 'a f CONTACT <br /> *, CUSTOMER NUMBER <br /> CUSTOMER EPA# <br /> / AMOUNT <br /> JOB SITE ADDRESS t. [,--' F s.4•" ! ._ CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT] <br /> NOTES: COMMODITY �,� ` ." <br /> HALIDESf'%" C'f C P.P.M. <br /> ,, NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGSREQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. `F; d C:> ,~ } i 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 Il,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831)427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave, a Fresno, CA 93722• CAD982446882 .(510)795-4400 <br /> DEMENNO/KERDOON •2000 N.Alameda Street-Compton, CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way a Dixon,CA 95620 a CAT080012602 e(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 55928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> ECYCLED AT OUR SISTER COMPANY DEMENNO/lKERDOON THE This Is ecertify th k"Che above named articles are properly classified,described, packaged, marked <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labelled,and in proper condition for transportation, according to the applicable regulations of <br /> the Department�#Transpartation. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY f. <br /> THER WASTE,THAT THE TOTAL HALIDES AHE LESS THAN 1000 P.P.M.; X <br /> D THAT THE WASTE DOES NOT CONTAIN ANY P.C.6'S.. C STOMEri SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL F <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X 4 :' <br /> ONTAINS ANY P.C.D'S. PRINT NAME <br />