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FORM NO. AES003 <br /> • _ • SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 13Q0: S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFF14E.,.. NORTHERN CALIFORNIA <br /> 1-800-748-5744 - EPACAD028277036 1-800-727-2879 <br /> a <br /> DATE rl 1 1 ONETIME RICK UF' OYES or L7fji)O,i <br /> CUSTOMER i +' +/)t 61 ! RESIDENCE 13 YES orX NO <br /> BILLING ADDRESS _ CONTRACT CUS70MER J� YES or 0 NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONEt, i:J n�{— If, /a:.# CONTACT CUSTOMERNUMBER <br /> CUSTOMER <br /> L tt�i <br /> CUSTOMER EPA#/� ``L GiiTC. t`9`1(tt <br /> P�WP AMOUNT <br /> JOB SITE ADDRESS /'I, + AL CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS " CASH RECEIVED <br /> _ IAMOUNT) <br /> l <br /> TTESr: r uxa i C ;COMMO,DITY <br /> HALIDES ..-',lG - P.P.M. <br /> ' NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED AILS)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 /> OT HER y DRUMS DRUM SIZE <br /> MANIFEST NO. NO_-__- <br /> .OF GALLONS <br /> l.a -•> , { <br /> DRIVER C , a` 't .'s'^It TRUCK NO.&RT '�I ._ <br /> ❑ NONHAZARDOUS DRAINED USED.OIL FI( R <br /> '❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City, CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL 5002)licher Street•'. 141so,�A 95542`;CAL090161743 0(51.0)476-1740 <br /> ❑ BAYSIDE OIL Il,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD08$83822$-7(408)427-3778 'y <br /> LJ EVERGREEN ENV..4139 N.Valentine Ave. .Fresno,CA 93722.CA0982446A82v4,,(5I0),795-4406 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street Compton,CA 90222•CAT080013352•(31r0)537-7100 <br /> ,2' DIK DIXON•7340 Chevron Way•Dixon,CA 95620.CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento;CA.95691.CAD044003656 .(916)371-5747 <br /> ❑ ASBURY 9NVIRONMENTAL SERVICES-2549 Scott Avenue.•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY - <br /> ' -'9 OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, described,packaged marked;:a� <br /> rCLED AT OUR SISTER.COMPANY DEMENNO/KERDOON THE and labeled,.and are in proper condition for Iransportation,according to the applicable regulations of <br /> .,;EST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Depwjme. <br /> nt.ofTransporta0on. <br /> t <br /> _ 1 - <br /> 'I HEREBY CERTIFY,THAT I HAVE NOT MIXED.THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X �-'- <br /> AND THAT THE 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 ISOVER 1000 P.P.M.TOTAL HALIDES, OR ' rf <br /> CONTAINS ANY:P.C.B'S. .> PRINT NAME <br /> y <br />