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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 635311 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> DIXON 1300 S. SANTA FE AVENUE 0 COMPTON,CALIFORNIA 90221 Li (310) 886-3400 <br /> UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE <br /> ONETIME PICK UP DYES or ONO <br /> CUSTOMER RESIDENCE 0 YES or 0 NO <br /> BILLING ADDRESS CONTRACT CUSTOMER 1:1 YES or 0 NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE <br /> CONTACT— CUSTOMER NUMBER <br /> CUSTOMER EPA# <br /> AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: <br /> COMMODITY <br /> HALIDES <br /> –RPM. <br /> ID NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> L NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> 71 OTHER DRUMS—DRUM SIZE <br /> MANIFEST NO. <br /> NO.OF GALLONS <br /> DRIVER <br /> TRUCK NO.&HT <br /> C1 NON HAZARDOUS DRAINED USED OIL FILTER <br /> F COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-487-9277 <br /> 1:1 ALTERNATE FACILITY <br /> DESIGNATEDTSDF: C AILVISO INDEPENDENT OIL-5002 Archer Street-Alviso,CA 95502- CAL000161743-(510)476-1740 <br /> 0 BAYSIDE OMI,INC.-210 Encinal Street-Santa Cruz,CA 95060-CAD088838222-(831) 427-3773 <br /> 0 EVERGREEN ENV..4139 N. Valentine Ave. e Fresno, CA 93722*CAD982446882 0 (510) 795-4400 <br /> -E DEMENNO/KERDOON -2000 N.Alameda Street-Compton, CA 90222-CAT08001 3352- (310)537-7100 <br /> 0 DIK DIXON*7300 Chevron Way e Dixon,CA 95620 e CAT080012602 e(707)693-6008 <br /> 0 RAMOS ENVIRONMENTAL.1515 S.River Road -W.Sacramento,CA 95691-CAD044003556 .(916)371-5747 <br /> 171 ASBURY ENVIRONMENTAL SERVICES-2549 Scott Avenue-Chico,CA 95928-CAL000827844 <br /> 0 ALTERNATE FACILITY <br /> JSED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> IECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON T This is to certify that the above named articles are properly classified, descrbed, packaged, marked <br /> HE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, 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 /> ND THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. <br /> CUSTOMER SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> IISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br />;ONTAINS ANY RC.B'S, PRINT NAME <br />