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. FORM NO.AFS003 <br /> SERVICE ORDER <br /> NO. N652513 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE Q COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888_603-88" <br /> DATE <br /> ONETIME PICK UP El YES or D NO <br /> CUSTOMER RESIDENCE <br /> ❑ YES or D NO <br /> BILLING ADDRESS <br /> CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE , ,� CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# c__ r f AMOUNT <br /> JOB SITE ADDRESS ' CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: <br /> COMMODITY <br /> HALIDES r PRM. <br /> ❑' 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 <br /> DRIVER '- TRUCK NO.&RT <br /> D NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> El ALTERNATE FACIL17Y <br /> DESIGNATED TSDF: O ALVISO INDEPENDENT OIL-5002 Archer Street-Alviso,CA 95502-CAL000161743.(510)476-1740 <br /> ❑ SAYSIDE OIL ll,INC.-210 Encinal Street•Santa Cruz,CA 95060-CAD088838222-(831) 427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. . Fresno, CA 93722 e CAD982446882.(510)795-4400 <br /> D DEMENNO/KERDOON -2000 N.Alameda Street-Compton,CA 90222•CAT080013352-(310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way a Dixon,CA 95620.CAT080012602.(707)693-6008 <br /> El RAMOS 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 <br /> ECYCLED 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 /> I 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 /> AD THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SiGNATUHE !DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> iISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br />�ONTAlNS ANY P.C.B'S. PRINT NAME <br />