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FORM NO.AE5003 <br /> --r SERVICE ORDER <br /> No. N652565 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE L] COMPTON, CALIFORNIA 90227 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 14300-727-2879 <br /> EPA CAD028277036 1-888-603-8844 <br /> DATE <br /> ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or L] NO <br /> �. <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> =1 SERVICE ORDER <br /> PNONE _ `'F " " ,� .w 7 (� (, CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# — s.L , 1 -Z AMOUNT <br /> JOB SITE ADDRESS Ca / `. CHECK NUMBER <br /> "l -°....-• '' r `:s A.,_..., P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY .. <br /> HALIDES. . r�r PPM. <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. ,.. i <br /> �,... � �..,. �,�,,,,, �.. ;1 ,,... NO.OF GALLONS <br /> DRIVER <br /> '. � `, ?RUCK NO.&HT <br /> r',, <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 11,INC.•210 Encinal Street•Santa Cruz,CA 95060-CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV. -4139 N. Valentine Ave. *Fresno, CA 93722 e CA0982446882-(510) 795-4400 <br /> �''DEMENNO/KERDOON -2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ D/K DIXON*7300 Chevron Way a Dixon,CA 95620 e CAT080012602*(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 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 certify and <br /> that the above named articles are properly classified,described, packaged, marked <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, and IabeSedd are in proper condition for transportation, according to the applicable regu€ations 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 P.P.M.; X <br /> ND THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br />'ONTAINS ANY RC.B'S. PRWTNAME <br />