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s <br />r: <br />0 FORM NO. AES003 <br />SERVICE ORDER <br />=- No. N665%50 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br />DIXON UNION CITY <br />14300-727-2879 EPA CAD028277036 1-888-603-8844 <br />DATE <br />CUSTOMER <br />BILLING ADDRESS <br />�. <br />PHONE i iF..,, x , % </4,'!" <br />CONTACT ,'r rlrr?+•":n <br />e <br />CUSTOMER EPA # "R lam' l" c `, C...= F' <br />JOB SITE ADDRESS ' / <br />CROSS STREETS <br />NOTES: <br />0' 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* <br />❑ OTHER <br />MANIFEST NO. <br />DRIVER <br />❑ NON HAZARDOUS DRAINED USED OIL FILTER <br />❑ SA RECYCLING, 2035 E. 15"' Street, Los Angeles, CA 90021 1-800-645-3458 <br />❑ ALTERNATE FACILITY <br />ONETIME PICK UP <br />RESIDENCE <br />❑ YES or ❑ NO <br />❑ YES or ❑ NO <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />CUSTOMER NUMBER <br />AMOUNT <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HALIDES ..- �'d�.'• c '� P.P.M. <br />NEXT SERVICE DATE <br />DRUMS DRUM SIZE <br />NO. OF GALLONS. <br />TRUCK NO. & RT. <br />DESIGNATED TSDF: ❑ <br />BAKERSFIELD TRANSFER INC. - 1620 E. Brundage Ln. • Bakersfield, CA 93307 • CAL000282598 • (661) 377-0308 <br />❑ <br />BAYSIDE OIL II, INC. - 210 Encinal Street -Santa Cruz, CA 95060 • CAD088838222 • (831) 427-3773 <br />❑ <br />EVERGREEN ENV. • 4139 N. Valentine Ave. • Fresno, Ck93722 . CAD982446882 . (510) 795-4400 <br />©'` DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ <br />D/K DIXON . 7300 Chevron Way • Dixon, CA 95620 . CAT080012602 • (707) 693-6008 <br />❑ <br />RAMOS ENVIRONMENTAL . 1515 S. River Road . W. Sacramento, CA 95691 . CAD044003556 . (916) 371-5747 <br />❑ <br />ASBURY ENVIRONMENTAL SERVICES • 2549 Scott Avenue • Chico, CA 95928 • CAL000827844 <br />❑ <br />ALTERNATE FACILITY <br />UaaD OIL, Ua)iD ANTIIPNaaia AND OILY WATUR WANTa ATNIIAMr Awa 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 of <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br />*1 HEREBY CERTIFY THAT I NOT MIXED THIS WASTEAN <br />OTHER WASTE, THAT THE TO ALEHALIDES ARE LESS THANWITH <br />P.P.MY X L I <br />AND 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 />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR <br />CONTAINS ANY P.C.B'S. PRINT NAME <br />