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FORM NO.AESOW <br /> _ _ __ _ • SERVICE ORDER <br /> No. N 595579 <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-S744 EPACAD028277036. 1-800-727-2879 <br /> DATE Afi� ' � 1 ONE TIME PICK UP DYES or P(NO <br /> CUSTOMER -'' ' c ;l r # 7 RESIDENCE ❑ YES or/NO <br /> 1 <br /> BILLING ADDRESS. CONTRACT CUSTOMER /YES or El NO <br /> PLEASE PAY FROM THIS <br /> ^T - SERVICE ORDER : / -7/ <br /> PHONE ':��1� '� `a* " I�-ld�t CONTACT CUSTOMER NUMBER `J'4:f-'. l4 /6o <br /> CUSTOMER EPA# (T AL 000 16a 1-� AMOUNT <br /> JOB SITE ADDRESS ) "I J A,;1. d .>_ +��': CHECK NUMBER <br /> r <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> ?TES: COMMODITY G4J O <br /> HALIDES G leVIO'O P.P.M. <br /> lcl NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> f *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 jj DRUMS DRUM SIZE <br /> MANIFEST NO. <br /> .tom �� .�. r7, l r�,_ NO.OF GALLONS f <br /> DRIVER )•' } r�.z f r TRUCK NO.&RT. <br /> ❑ NONHAZARDOUS DRAINED USED OIL FIL R <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 /> .. ❑ BAYSIDE 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 /> ❑ DIK 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 /> 'D OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles re properly classified, described, packaged,marked <br /> YCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are in proper condition for articles <br /> Ion according to the applicable regulations of <br /> —.HGEST AECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation <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 /> 9 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS DYER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINTNAME <br />