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FORM NO.AES003 <br /> - - - = SERVICE ORDER <br /> y IVO. N 9028899 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE COMPTON. CALIFORNIA 90221 n (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-6038844 800-733-9043 666-994-6937 <br /> DATE ONE TIME PICK UP 17,YES or ❑NO <br /> CUSTOMER RESIDENCE <br /> ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER Ci YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <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 /> (AMOUNTI <br /> NOTES: _ COMMODITY <br /> — <br /> HALIDES PPM. <br /> ❑ 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 <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 /> J USED OIL AND GASOLINE FILTERS <br /> +� SA RECYCLING, 33210 Western Avenue.Union City,CA 94587 1-510-487-9277 <br /> J ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC• 1618 W.5th St..Chico,CA 95928•CA0980694103•(800)733-9043 <br /> © 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•CAL000282598•(661)377-0308 <br /> ❑ D/K DIXON•7300 Chevron Way•Dixon,CA 95620•CATD80012602•(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 <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certify that the above named articles are properly classified, described, packaged, marked <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and laheled,and are in proper Condition for transportation,according to the applicable regulations of <br /> 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 I <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE DATE <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> CONTAINS ANY PC B'S. PRINT NAME <br />