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FORM NO.AES003 <br /> . _ _ __ _ • SERVICE ORDER <br /> No. N 595665 <br /> 1 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> y 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> i 1-800-748-5744 EPACAD028277036 1-800-727-2879 <br /> i <br /> t <br /> DATE i=: L.- - i": ONETIME PICK UP El YES or /NO <br /> CUSTOMER I RESIDENCE ❑ YES or �1 NO <br /> BILLING ADDRESS CONTRACT CUSTOMER C4 YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER 'i' (- 7L <br /> 1 <br /> CUSTOMER EPA# /")Q1 ['.:.{'1E"}j j Imo,i I[,n AMOUNT <br /> JOB.SITE-ADDRESS ) I I IY .�A,-I. CHECKNUMBER <br /> ,(i <br /> - n 1'"!:.- -.`7�G P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> '?TES: COMMODITY I;.tk <br /> j. <br /> HALIDES -f 1!Fe4 RRM. <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 /> MANIFEST NO. �>�,tT����� � )� "1 X "C/... NO.OF GALLONS <br /> v <br /> DRIVER � � , ry 1 �'k� l{`� ,. \-4": TRUCK NO.&RT. 7,� <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILT 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 /> �❑-�,r DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> Sd D/K DIXON•7300 Chevron Way.Dixon,CA 95620.CAT080012602•(707)6938008 <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 /> -gyp OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly ppI'assified, described, packaged, marked <br /> )YCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are In proper condition for Iranspdrtahon„Zccordmg to the applicable regulations d <br /> .._.(GEST RECYCLER 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 a - ” ' -" ( /07 <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE - DATE <br /> "I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES.FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />