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FORM NO.AES003 <br /> SERVICE ORDER <br /> "s �z <br /> ASBURYENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE 11COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE ` ONETIME PICK UP El YES or ❑NO <br /> CUSTOMER <br /> RESIDENCE <br /> D YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT <br /> CUSTOMER NUMBER <br /> CUSTOMER EPA# _. AMOUNT <br /> JOB SITE ADDRESS 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 /> O OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER 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: d ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743•(510)476-1740 <br /> 0 BAYSIDE OIL If,INC.•210 Encinaf Street•Santa Cruz, CA 95060•CAD088638222•(831) 427-3773 <br /> EVERGREEN ENV. .4139 N. Valentine Ave • Fresno, CA 93722•CAD982446882 • (510)795-4400 <br /> C7 DEMENNO/KERDOON •2000 N.Alameda Street•Compton, CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way.Dixon,CA 95620 e 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 /> ❑ ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to cern that the above named articles are rp er1 classified, described. Packaged, marked <br /> ECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE �` P P Y <br /> RGEST 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 /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> HER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X ' <br /> D THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> SPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> NTAINS ANY P.C.D'S, PRINT NAME <br />