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FORM NO.AES003 <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 a (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE �7 f ONE TIME PICK UP ❑YES or ❑NO <br /> F <br /> CUSTOMER RESIDENCE El YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE : ,; CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# r ',"z AMOUNT <br /> JOB SITE ADDRESS • '"f- F' �•-. CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <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 7 <br /> TRUCK NO.&RT . <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 /> F DEMENNO/KERDOON •2000 N.Alameda Street•Compton, CA 90222•CAT080013352•(310)537-7100 <br /> ❑ D1K DIXON e 7300 Chevron Way e Dixon,CA 95620 e CAT080012602 e(707)693-6006 <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 This is to certify that the above named articles are properly classified, described, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation, according to the applicable regulations d <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of re Transportation. <br /> c. <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 />�NDTHATTHE WASTE DOES NOT CONTAIN ANY P,C.B'S.. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL. <br /> IISPOSAL IF THIS WASTE IS OVER 1000 RPM.TOTAL HALIDES, OR <br />,ONTAINS ANY PC.B'S. PRINT NAME <br />