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FORM NO.AES003 <br /> • _ • SERVICE ORDER <br /> EWA <br /> No. N 566466 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNLA <br /> F 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE i ' ->c —7 ONE TIME PICK UP ❑YESor/NO <br /> n <br /> CUSTOMER -i i n t+3 t I£{ l RESIDENCE ❑ YES or/NO <br /> CONTRACT CUSTOMER /YES or ❑ NO <br /> BILLING ADDRESS <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER' <br /> PHONE J I7 # ., i t�Lr�L P� CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# /!Pit Xe ) I£3t?li+,$�,,t LE � AMOUNT ! t <br /> JOB SITE ADDRESS 9715 t''j�--t' � l CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> COMMODITY—AyES: O <br /> HALIDES "mfr' - P.P.M. <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 133 <br /> NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS _ DRUM SIZE <br /> MANIFESTNO. ,i CJ^• lf f� A NO.OF GALLONS ' /150 <br /> DRIVER •.,:.. r'..7y f ."j," C '.�,c:i <br /> I TRUCK NO.&RT. .1 frJO <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILT <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CAS 510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•AlvisO,CA 95502•CAL000161743.(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427-3778 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave. . Fresno, CA 93722.(510)795-4400 <br /> ❑ DEMENNO/Y.ERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> D/K DIXON.7300 Chevron Way.Dixon,CA 95620.CAT080012602.(707)6936008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road W.Sacramento,CA 95691.CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-•2549 Scott Avenue•Chico,CA 95928•CAL-000827844 <br /> ❑ ALTERNATE FACILITY - <br /> L 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 /> R._ .CLED 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 OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation.. <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH. ANY / I / ;y l4/ <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X CusiOMER SIGNATURE FATE <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. <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 XF '_ PRINT NAME <br /> CONTAINS ANY P.C.B'S <br />