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FORM NO.AES003 <br /> I` SERVICE ORDER <br /> NoOW <br /> . N 6725.05 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 o (310)886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1888 6038844 <br /> DATE ?S• f!/ '1 ONETIME PICKUP ❑YES or p NO <br /> CUSTOMER 1 n�. !:>-_ r r:_-.,;":•s d�. ri RESIDENCE ❑YESor Q NO <br /> .. f <br /> ). CONTRACT CUSTOMER §kYES of ❑ NO <br /> BILLING ADDRESS r` �+ + ii" <br /> PLEASE PAY FROM-ANIS <br /> L1:1r [.�rs,,rl +/ ' ty SERVICE ORDER <br /> TT' , in `t t . <br /> PHONE I f i;—C)l:::•r l CONTACT CUSTOMER NUMBER <br /> r1.-;-; (:r r: .: l f.1 t i:I7 <br /> .•,"• <br /> >z":, •/ AMOUNT. Ir/c- 5 <br /> CUSTOMER EPAq <br /> + .! CHECK NUMBER <br /> JOB SITE ADDRESS 1,r?%1 'I i 1!-ti r=r n i { „i� <br /> 1 <br /> 1 r P.O.NUMBER <br /> •l r•'_.7:•'.7: fir_. '1.h1•�' .. - <br /> CROSS STREETS 1' CASH RECEIVED <br /> (MOUND <br /> ND <br /> NOTES: COMMODITY /09 <br /> HALIDES _�) P.P.M. <br /> Q NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILJMIXEO 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 <br /> DRUMS % DRUM SIZE ; <br /> MANIFEST NO. t i )4°� NO.OF GALLONS <br /> ' TRUCK NO.&HT. <br /> DRIVER <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> Cl SA RECYCLING, 2035 E.Is'"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 /> _ LIBAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222• 83 1)427.3773 <br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ DEMENNO/KERDOON•2000 N.Alameda Street•Compton.CA 90222•CAT080013352•(310)537-7100 <br /> IK DIXON•7300 9hevron Way•Dlxon,CA 95620•CAT080012602•(707)693 6008 <br /> ❑ OS ENVIRON ENT .1515 S.Hive(Road..W.Sacramentd,CA 95691.CA0044003556 .(918)371-5747 <br /> ❑ BURY N.YY� ME L SERVICES 2549 Scott Avenue.Chlco,CA 95928•CAL000827844 <br /> ❑/ T EFA 70/U) <br /> USED OIL,USED ANTIFfiEEZE ND OILY WATE• WASTE STREAIdS ARE This Is to certify that the alcove named articles are properly classified,described,packaged,marked <br /> RECYCLED AT OUR-SISTEQ OMPA Y DEMENHO/ ERDOON THE and labeled,and are to proper condition for transportation,according to the applicable regufaG_ogs of <br /> r LARGEST REOYCCER OF USED OIL IN��l <br /> EWESTERN-UNITED STATES.• Ibe Departmari(ofTransportation'1 HEREBY CERTIFY THAT I HAVE NOT ED THIS WASTE WITH ANY , � t i / �./ , /�l <br /> OTHER WASTE,THAT THE TOTAL HALIDARE LESS THAN 1000 PPM.; 'X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. a y CUSTOMER SIGNATURE r <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 PRINT NAME 5 <br /> CONTAINS ANY P.C.B'S. ` <br />