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FORM NO.AES003 <br /> SERVICE ORDER <br /> - - - NO. N ,9258 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FF AVENUE ❑ COMPTON,CALIFORNIA 90221 0 (330) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE '' ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER �1 1 IA,. rY <br /> RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE <br /> _ -� 1 :- `� � ' � .d.tir.,�,� d CONTACT �' .r,�,l CUSTOMER NUMBER <br /> CUSTOMER EPA# / AMOUNT <br /> JOB SITE ADDRESS ' S <br /> CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES _RPM. <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. el- c" " � NO.OF GALLONS <br /> DRIVER _ TRUCK NO.&RT ' <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City, CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSD F: ❑ 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*CA0982446882 * (510)795-4400 <br /> I&'DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON*7300 Chevron Way*Dixon,CA 95620*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 /> C] ALTERNATE FACILITY <br /> SED 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 /> ECYGLED A7 OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are in proper condition for transportation, according to the applicable regulations of <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, the Department of Transportation. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> THEIR WASTE,THAT THE TOTAL HALIDES ARE: LESS THAN 1000 P.P.M.; <br /> NO THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE <br /> 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 P.C.B'S. PRINT NAME <br />