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FORM NO.AES003 <br /> . _ SERVICE ORDER <br /> No. N 584351 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑. COMPTON,CALIFORNIA 96221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE a . I Le - ONE TIME PICK UP DYES or /NO <br /> CUSTOMER ' ' ,� RESIDENCE ❑ YES or [/NO <br /> J: <br /> BILLING ADDRESS CONTRACT CUSTOMER OYES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE 2tl)qf)). lo" ,>li !CONTACT CUSTOMER NUMBER F � <br /> CUSTOMER EPA N C'Q L 000 I F��{''I'Ifr AMOUNT <br /> JOB SITE ADDRESS �'f I J R( r .7 Y'`�t -�"`•"� ' CHECK NUMBER <br /> -1 •? 1 t . I. J P.O.NUMBER <br /> t� <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> COMMODITY. tf�°:. <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* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> '''y <br /> MANIFEST NO. r ��( �1If7 f NO.OF GALLONS I/III()`-' <br /> DRIVER I - TRUCK NO.&RT. <br /> Z 7 <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTO <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street.•Alviso,CA 95502•CAL000161743.(510)476-1740 <br /> ElBAYSIDE OIL II,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 •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> D/K DIXON•7300 Chevron Way*Dixon,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 named articles are properly classified,described,packaged, marked <br /> REs..7LED 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 -`.�' "^ ...- - / a / %��e9 f <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 100b,P.P.M.; X <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. :CUSTOMER SIGNATURE DATE <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 />