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FORM NO.AFS003 <br /> - - - =- SERVICE ORDER <br /> No. N .9u3333 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 L7 (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 En YES or u NO <br /> BILLING ADDRESS CONTRACT CUSTOMER E3 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 /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES PPM. <br /> I_.J NON RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED 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* NEXT SERVICE DATE <br /> `-i 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 /> ^1 ALTERNATE FACILITY <br /> DESIGNATED TSDF: f_! ASBURY ENVIRONMENTAL SERVICES-2549 Scot Avenue-Chico,CA 95928•CAL000827844 <br /> Cl ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC• 1618 W.5th St..Chico,CA 95928-CAD980694103-(80011733-9043 <br /> L 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+CAT090012602-(707)693-6008 <br /> ❑ DEMENNO/KERDOON-2000 N.Alameda Street-Compton.CA 90222-CAT080013352-(310)537-7100 <br /> r 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 /> F1 WORLD OIL-SAN JOAQUIN,LLC- 14287 F 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 for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER CF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> 11 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE L1ATE <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR <br /> CONTAINS ANY RC.B'S PRINT NAME <br />