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RE- <br />FORM NO. AES003 <br />SERVICE ORDER <br />ENvI <br />4L HEALTH <br />c <br />_ No. N <br />9029133 <br />"7.NT <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE D COMPTON, CALIFORNIA 90221 n 1310) 886-3400 <br />EPA% CAD028277036 <br />DIXON <br />UNION CITY CHICO FRESNO <br />' <br />800-727-2879 <br />888-603-8844 600-733-9043 866-994-6937 <br />DATE <br />CUST <br />BILLING ADDRESS <br />ry,� v/�• % /yam, <br />PHONE W l �V�' ��A/}-�/ `1i I CONTACT <br />CUSTOMER EPA ^ v J ''"�� <br />JOB SITE ADDRESS � J' N tl /In C4 <br />516.5 6 --moi q 52 f'Z <br />CROSS STREETS <br />NOTES: <br />NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED 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' " <br />❑ <br />MAt <br />DRP <br />1-1 <br />USED OIL AND GASOLINE FILTERS <br />SA RECYCLING, 33210 NN//((��aste�rn Avenue, Union CKy, CA 51587 1-510-487-9/27�7 <br />.ALTERNATE FACILRV !7"F S � Dl%� �� z f <br />ONETIME PICKUP OYES or ❑ NO <br />RESIDENCE O YES or 0 NO <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />CUST ER NUMBER <br />AMO � <br />CHEC NUMBER <br />RCKNUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY coMMo01TY <br />HALIDES __ _P.P.M. <br />NEXT SERVICE DATE <br />DRUMS - D UM SIZE <br />NO. OF GALLONS <br />TRUCK NO. & RT. <br />DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico, CA 95928 • GALOOGS27844 <br />❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II, LLC • 1618 W. 5th SI., Chico. CA 95928 • CAD980694103 • (800) 733-9043 <br />❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA • 200 Dinsmore Dr., Fortuna, CA95540 • CAL930256136 • (800) 733-9043 <br />❑ BAKERSFIELD TRANSFER INC. • 1620 E. Bmndage Ln. • Bakemnaid, CA 93307 • CAL000282598 • MI) 377-0308 <br />❑ D/K DIXON • 7300 Chevron Way • Dixon, CA 95620 - CAT08W 72602 • V07) 693-6008 <br />❑ DEMENNO/KERDOON • 2000 N. Alameda Street r Compton. CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ EVERGREEN ENV. • 4139 N. Valentine Ave. • Fresno, CA 93722 • CAMS2446Se2 • (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. • Padier, CA 93640 • CAUX30102751 • (559) 498-0240 <br />❑ ALTERNATE FACILITY <br />USED OIL, USED ANTIFREEZE ANDDILY WATER WASTE STREAMS ARE <br />RECYCLED AT, OUR SISTER COMPANY OEMENNOMERDOON THE <br />LARGEST RECYCLER OF USEDOILIN THE WESTERN UNITED STATES. <br />'I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />INHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; <br />D THAT THE WAS7E DOES NOT CONTAIN ANY PC.B'S.. <br />'1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br />pISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR <br />DONTAINS ANY P.C.B'S. <br />This Is to midy that the above named ankles are jxopM y <br />classiSed, described, Packaged. marked <br />and labeled, and are in Proper cond don W transponalion, according 10 the apfxlrabla regulations or <br />tho Depmtme^nt of TranspNWion. r / <br />X <br />- q^ CUSTOMER Stti"t UU— f— DATE <br />X / "!G/ Imo? IJ /?,-; <br />, <br />PAINT NAME <br />