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CORM NO.AESOU3 <br /> - - -- SERVICE ORDER <br /> No. N <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE :� COMPTON, CALIFORNIA 90221 F i (310) 586-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE ONE TIME PICK UP ❑YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER 0 YES or ❑ NO <br /> PHONE CONTACT 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 OlUMIXED OILS)STAIE CGDE 221 <br /> "NO PLACARDS REQUIRED" <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> 'NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> OTHER — DRUMS -_—DRUM SIZE <br /> MANIFEST NO. _ _ NO OF GALLONS <br /> DRIVER TRUCK NO.$RT. <br /> 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: [ I ASBURY ENVIRONMENTAL SERVICES-2549 Scot Avenue-Chico,CA 95928+CAL000827844 <br /> [] ASBURY ENVIRONMENTAL SERVICES-CHICO 11,LLC• 1618 W.5th St.,Chico,CA 95928+CAD9Bo694103-4800)733-9043 <br /> __j ASBURY ENVIRONMENTAL SERVICES-FORT UNA•200 Dinsmore Dr.,Fortuna,CA 95540-CAL930256136-(800)733-9043 <br /> BAKERSFIELD TRANSFER INC. -1620 E.Brundage Ln.- Bakersfield,CA 93307-CALOOD28259B-(661)377-0308 <br /> D/K 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.-Parlier,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 properly classified,described,packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO KERDOON THE and labeled,and are in proper Condition tur transportation,according to the applicable regal lions of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> +l HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPWM X I <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE DATE <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE 1S OVER 1000 PPM-TOTAL HALIDES. OR <br /> CONTAINS ANY PC.BB'S PRINT NAME' <br />