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RECEIVED <br />APR 10 2017 <br />ENVIRONMENTAL HEALTH ASBURY ENVIRONMENTAL SERVICES <br />DEPARTMENT 1300 S. SANTA FE AVENUE O COMPION, CALIFORNIA 90221 ❑ <br />EPAB CAD028277036 <br />DIXON UNION CITY CHICO <br />800-727-2879 868-603-8844 800-733-9043 <br />FORM NO. AES003 <br />SERVICE ORDER <br />No. N 9054046 <br />(310)886.3400 <br />FRESNO <br />866-994-6937 <br />DATE �_ ID C-7 F ONE TIME PICK UP OYES or O NO <br />CUSTOMER 0 /I RESIDENCE ❑ YES or ❑ NO <br />BILLING ADDRESS - CONTRACT CUSTOMER OYES or'❑NO <br />PHONE 2-nq 7I �I - CONTACT CUSTOMER NUMBER <br />CUSTOMER EPAM E ,y`� / :i( in;l['r _ AMOUNT 1 <br />JOB SITE ADDRESS 2./ L_ � i CHECK NUMBER <br />Z <br />CROSS STREETS <br />NOTES: <br />❑ NON-ACRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br />•NO PLACARDS REQUIRED' <br />P.O. NUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HALIDES P.P.M. <br />-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE ( ' <br />PLACARDS OR MARKINGS REQUIRED' - r ✓ NEXT SERVICE DATE <br />Q OTHER <br />MANIFE' <br />DRIVER <br />❑ USED OIL AND GASOLINE FILTERS <br />❑ SA RECYCLING, 33210 Western Avenue; Union City, CA 94567 1-510-487-9277 <br />ALTERNATE <br />DRUMS DRUM SIZE <br />NO. OF GALLONS _ �0 <br />TRUCK NO. &, RT. <br />2c? -5 -1-!59: <br />DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico, CA 95928 • CAL000627844 <br />❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II, LLC • 1618 W. 51h SI., Chico, CA 95928 • CAD980694103 • (800) 733-9043 <br />❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA • 200 Dinsmore Or., Fortuna, CA 95540 • CAL930256138 • (800) 733-9043 <br />❑ BAKERSFIELD TRANSFER INC. • 1620 E. Brundage Ln, • Bakersfield, CA93307 • CAL000282698 • (661) 377-0308 <br />❑ D7K DIXON • 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008 <br />❑ DEMENN07KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ EVERGREEN ENV. • 4139 N. Valentine Ave. • Fresno, CA 93722 • CAD062446082 • (510) 795-4400 <br />❑ RAMOS ENVIRONMENTAL • 1515 S. River Road • W. Sacramento, CA 95691 • CAD0440D3556 • (916) 371-5747 <br />❑ WORLD OIL -SAN JOAQUIN, LLC • 14287 E. Manning Ave. • Parlier, CA 93648 • CAL000102761 • (559) 498-0240 <br />❑ ALTERNATE FACILITY <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This E to cattily that tits above named alaIXes are p,opedy damned. described. packaged, markedRECYCLED AT OUR SISTER COMPANY DEMENNOlKEROOON THE and labeled, and are in proper condition for InanspadatvaU, according to the epplicade regulations of <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. In, Department of Tianspurta6on. <br />•I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY1--- <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.; X <br />ANOTHAT THEWASTE DOES NOT CONTAINANY P.C.B'S.. '1 CUSTOMER SIGNATURE <br />'t FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X / /G��. /T Pr 1 <br />rr <br />DISPOSAL IF THIS WASTE IS OVER Woo RPM. TOTAL HALIDFS, OR � ( <br />CONTAINS ANY PC D'S. U P iff NAME <br />