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• • FORM NO.AES003 <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 11 (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE {� tF,.'Y ONETIME PICK UP El YES or Q NO <br /> CUSTOMER a_,r=-: r<:..", RESIDENCE ❑ YES or Q NO <br /> F <br /> BILLING ADDRESS _ ! ":. ,; r CONTRACT CUSTOMER .[]AYES or❑ NO <br /> �.� ., 1 1 G f`,a PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE az t, CONTACT rr:r.. ;r: CUSTOMER NUMBER r ! tj <br /> AMOUNT <br /> CUSTOMER EPA# ' <br /> tC� 4' F `: 13 +L <br /> J08 SITE ADDRESS ", :�' ,`r:r 1 >? . CHECK NUMBER <br /> y,. <br /> P.O.NUMBER <br /> CROSS STREETS %� r =i. _ - CASH,RECEIVED <br /> p. (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES - '= P.P.M. <br /> D 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 /> ❑ OTHERDRUMS DRUM SIZE <br /> t MANIFEST NO. !' NO.OF GALLONS <br /> f � { t ' • <br /> a <br /> DRIVER s , TRUCK NO.&RT. a <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ $A RECYCLING, 2035 E.15TH Street,Los Angeles,CA 90021 1-800-645-3458 <br /> ?.. ❑ ALTERNATE FACILITY <br /> ' DESIGNATED TSDF: ❑ BAKERSFIELD TRANSFER INC.-1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ;'. ElBAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CADOSS838222•(831)427-3773 <br /> c-< ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ DEMENNO/KEItDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> RqIK DIXON•7300 9hevron Way•Dixon,CA 95620.CAT080012602•(707)693-6008 <br /> El MMOS ENVIRON ENT .1515 S.Rive(Road.W.Sacramento,CA 95691.CAD044003556 .(9116).371-5747 <br /> ❑ A BURY N I MEN AL SERVICES 2549 Scott Avenue ]CO CA 95928•CAL000827844 <br /> ElT+ EFA Ll / <br /> y USED OIL,USED ANTIFREEZE ND OIL WATE WASTE STREAMS ARE This is to certify that the above named articles are properly classified,described,packaged,marked <br /> F;c RECYCLED AT OUR-- lSTERyCOMPA Y DEMENNO/ICERDOON THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN HE WESTERN-UNITED STATES., the DepartmerjofTransportation.. <br /> z *I HEREBY CERTIFY THAT I HAVE NOT Iy11XED THIS WASTE WITH ANY I. + <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; 'X � ' �� L-:- <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DAA <br /> >, J <br /> *I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br /> M�':. <br />