Laserfiche WebLink
FORM NO.AES00" <br /> = _ SERVICE ORDER <br /> NO. N 9028945 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE i.r COMPION. CAUL ORNIA 90221 (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 ONE TIME PICK UP YES or ❑NO <br /> CUSTOMER RESIDENCE YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ 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 /> rA-OUNTl <br /> NOTES: _ COMMODITY <br /> HALIDES PPM. <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(USED 01LJMIXED OILS)SIATE 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.B 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: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO Il,LLC• 1618 W.5th St.,Chico,CA 95928•CAD980694103•1800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•1800)733-9043 <br /> 0 BAKERSFIELD TRANSFER INC, • 1620 E. Brundage Ln. •Bakersfield,CA 93307•CAL000282598•(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.•-1139 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 certifythat the above named articles are properly classified,described, packaged, marked <br /> RECYCLED C OUR SISTER COMPANY D WESTERN i NITER SN THE and labefed,and are in proper cundilion for irarisporptetun.according to the applocable regulations of <br /> LARGEST REGYGLER OF USED DEL IN THE WESTERN UNITED 'STATES. the Department of Transportation. <br /> a <br /> 'I HEREBY CERTIFY THAT ! HAVE NOT MIXED THIS WASTE WITHANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P?P?M., X I f I <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SiCaNAruRE - DATE <br /> 4 <br /> '1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PP.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME - <br />