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FORM NO.AFS003 <br /> i _ _ • SERVICE ORDER <br /> No. N 583302 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> .1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 -1-800727-2879 <br /> DATE ' " `7 ONETIME PICK UP [I YES or/NO <br /> CUSTOMER ' r � <- -° I ) j 7 J RESIDENCE ❑ YES orNO <br /> BILLING ADDRESS CONTRACT CUSTOMER BYES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE .�t. f} { -� _ 1b,1, CONTACT CUSTOMER NUMBER 'h . <br /> CUSTOMER EPA# (l At COO 1.f 14 1111 AMOUNT <br /> JOB SITE ADDRESS `E ^! /J. b4.f--#-^�y� �'� CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> ES. COMMODITY &r ._ <br /> HALIDES P.P.M. <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED 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* <br /> ❑ OTHER NEXT SERVICE DATE <br /> DRUMS DRUM SIZE <br /> . ^g ) �J j <br /> MANIFEST NO. - . ;t l..f { `f +' NO.OF GALLONS <br /> DRIVER I)-^ <br /> v_t`3 (.,°5T :. TRUCK NO.&RT '7r J 7 <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTE. <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATEDTSDF: ❑ 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•CAD982446882• (510)795-4400 <br /> ❑ DEMENNO/KERDOON •2000N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> D/K DIXON•7300 Chevron Way•Dbron,CA 95620•CAT080012602•(707)693-6008 <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•CAL000827844 <br /> ❑ ALTERNATE FACILITY ` <br /> U: )IL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above namgd articles are properly classified,described, packaged, marked <br /> RE­,;LED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled and are inproper con�ftlon for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation y <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY f ,. �' / :: / �— <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X CUSTOMER SIGNATURE DATE <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS:WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR PRINT NAME <br /> CONTAINS ANY P.C.B'S. <br />