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FUKM NU.AtJW3 <br /> SERVICE ORDER <br /> No. N 598073 <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 EPACAD028277036 1-800-727-2879 <br /> DATE ONETIME PICK UP El YES or/NO <br /> ry9 r <br /> CUSTOMER + iti�1.E ;�tt�`"} RESIDENCE ❑ YES or/ NO <br /> S <br /> BILLING ADDRESS CONTRACT CUSTOMER /YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> <r t <br /> PHONE �'(fes � L}P x' A CONTACT CUSTOMER NUMBER i - /c 71, <br /> CUSTOMER EPA N I'k)L: 0Q0 I As` Z. 1,111 L AMOUNT <br /> JOB SITE ADDRESS ')') ) F AI • >.t i:4:! CHECK NUMBER <br /> -�r") (• j. r{L P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> �9TES: COMMODITY-40— <br /> HALIDES <br /> OMMODITYp.,L 0HALIDES <-'fL?Cf{} 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 /> MANIFESTNO. I7f)T I f ISS{�• z�7 ?SC NO.OF GALLONSo,7 CJ <br /> DRIVER .. ', C,ts TRUCK NO.&RT. <br /> ❑. NONHAZARDOUS DRAINED USED OIL FILTER, <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> Ell , 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 /> D/K DIXON•7300 Chevron Way•Mon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road W.Sacramento,CA 95691.CA0044003556 .(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 are properly classified,described, packaged,marked <br /> CLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are in proper condition for transportation;according to the applicable regulations of <br /> rt EST 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 1060 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 IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />