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FORM NO.AES003 <br /> SERVICE ORDER <br /> -=• NO. NQ3 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE LlCOMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON1300 <br /> CITY <br /> 1-800-727-2879 EPA C4D028277036 1-888-503-8844 <br /> DATE ` •fY ; ? <br /> ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER f �� .,;-V•2.�. .. <br /> �J .tF'" x '' RESIDENCE ❑ YES or 0 NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> _ SERVICE ORDER <br /> PHONE_ t,. `__7 fa < 4t CONTACT 7` 4'�� r <br /> CUSTOMER NUMBER <br /> CUSTOMER EPA# � AMOUNT <br /> JOB SITE ADDRESS - r.. -` CHECK NUMBER <br /> t <br /> P.Q.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES PPM. <br /> _, NON-RCRA HAZARDOUS WASTE,LIQUID(USED OVMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> NON-NONHAZARDOUS 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. <br /> �,,, .s".�'c'"`' �r..''' � � .''r ...� s` I+'�y _ NO.OF GALLONS •? 41 <br /> DRIVER i 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 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 /> E� DEMENNO/KERDOON •2000 N.Alameda Street•Compton.CA 90222•CAT080013352• (310)537-7100 <br /> ❑ D/K DIXON.7300 Chevron Way.Dixon,CA 95620•CAT080012602 a(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 /> JSED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> 1ECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certity that the above named articles are properly classified, described, ,packaged, marked <br /> pe <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled,and are in_prer condition for transportation,according to the applicable regulations of <br /> the Department 6fTian9portation. <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.; <br /> SND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. <br /> CUSTOMER SIGNATURE GATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br />)ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br />,ONTAINS ANY P.C.B'S. PRINT NAME <br />