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FORM NO. AES003 <br />SES_ - <br />- — No. N 576408 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br />SAN DIEGO OFFICE NORTHERN CAUFORNIA r <br />1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br />CUSTOMER <br />BILLING ADDRESS <br />PHONE `'.'' , CONTACT <br />CUSTOMER EPA # 4 t <br />JOB SITE ADDRESS <br />CROSS STREETS <br />NOTES: <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* <br />❑ OTHER <br />MANIFEST NO. <br />.f <br />DRIVEP. <br />❑ NON HAZARDOUS DRAINED USED OIL FILTER <br />❑ COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City, CA, 510-487-9277 <br />❑ ALTERNATE FACILITY <br />ONE TIME PICK UP ❑YES i -r IIiik <br />RESIDENCE ❑ YES or Q N <br />CONTRACT CUSTOMER ❑ YES dF'N <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />CUSTOMER NUMBER <br />AMOUNT <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />COMMODITY <br />HALIDES `J ' RPM. <br />NEXT SERVICE DATE <br />DRUMS DRUM SIZE <br />NO. OF GALLONS C. <br />1RUCK NO. & R T. <br />DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL - 5002 Archer Street • Alviso, CA 95502 • CAL000161743 • (510) 476-1740 <br />❑ BAYSIDE OIL 11, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CAD088838222 • (408) 427-3778 <br />❑ EVERGREEN ENV. • 4139 N. Valentine Ave. • Fresno, CA 93722 * (510) 795-4400 <br />❑ DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />Q. DA( DOWN . 7300 Chevron Way . Dixon, CA 95620 • CAT080012602 * (707) 693-6008 <br />C RAMOS ENVIRONMIENTAL . 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 />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are property classified, described, packaged, marl <br />RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled and are in proper condifion for transportation, according to the appbcable regtllati0ns <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 F <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.; X . t'' 11 <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE MiE <br />*1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X t <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR V <br />CONTAINS ANY P.C.B'S. PRINT NAME <br />