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FORM NO.AES00 1 <br /> - - SERVICE ORDER <br /> No. N 90?�iO4 <br /> ASBURY ENVIRONMENTAL. SERVICES <br /> 1300 5, SANTA FE AVENUE to COMPTON, CALIFORNIA 90221 o (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE ONETIME PICKUP L1 YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or O NO <br /> BILLING ADDRESS CONTRACT CUSTOMER t1 YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB S1TE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> taMouNT1 <br /> NOTES, COMMODITY, <br /> HALIDES P.P.M. <br /> LI NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> L NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> *NO PLACARDS OR MARKINGS REQUIRED* <br /> NEXT SERVICE DATE <br /> ❑ OTHER _ DRUMS DRUM SIZE <br /> MANIFEST NO. _ NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. <br /> D USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chino,CA 95928•CAL000827844 <br /> ❑I ASBURY ENVIRONMENTAL SERVICES-CHICO It,LLC•1618 W.5th St.,Chico,CA 95928•CAD980694103•(800)733-9043 <br /> p ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. • 1620 E.Brundage Ln.•Bakersfield.CA 93307•CAL000282596•(661)377-0308 <br /> ❑ DIK DIXON•7300 Chevron Way•Dixon.CA 95620•CAT080012602•(707)693-6008 <br /> )❑ DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL• 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ® WORLD OIL-SAN JOAQUIN,LLC•14287 E.Manning Ave. •Parfier,CA 93648•CAL000102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are property classified,described, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DFMFNNOIKERDOON THE and labal©d, and aro in proper condition for transportalion,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 HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE.THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM., X �� I <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY PC B'S CUSTOMER SCGNATURE DATE <br /> •1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 RPM. TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />