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SEP-20-2010 09:50A FROM:YANDELL TRUCKAWAY T 2098355060------C Tn:4683433 P.6 <br /> FORM NO.AES003 I <br /> SERVICE ORDER <br /> ==i. sa n= <br /> -No. 639056 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> DIXON <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221Li (310) 886-3400 <br /> 1-800-727-2879 EPA CAD028277Q36 UNION CITY <br /> 1.888-603.8844 <br /> DATE <br /> ONETIME PICK UP OYES or ONO <br /> CUSTOMER 't`x f r s f ?',r:r .f' •r` r f2ESIDENGI; 0 YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER 0 YES or Q NO <br /> PLEASE. PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE <br /> CONTACT f! CVSTQMER NUMBER <br /> #"'"s,.,r,�y�..«� ,.,, <br /> CUSTOMER EPA N ..` .� �w <br /> _._.. AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> Y <br /> PO.NUMBER I <br /> r , <br /> i <br /> i <br /> CROSS STREETS CASH-RECEIVED <br /> (AMOUNT) i <br /> NOTES: COMMODITY e r. . <br /> HALIDES --gfe'P A9 P.RM. <br /> Q` NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATF CODE 221 <br /> *NO PLACARDS REQUIRED* j <br /> i <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS.REQUIRED* NEXT SERVICE DATE i <br /> J <br /> ❑ OTHER DFIUMS DRUM SIZE <br /> MANIFEST NO. f C�'. C`,a� ^"" l ��°" 'NO.OF GALLONS <br /> DRIVER <"`* � TRUCK NO.&RT.. ." <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> I , <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487.9277 I <br /> ❑ ALTERNATE FACILITY <br /> � j <br /> DESIGNATED TSDF: 0 ALVISO INDEPENDENT OIL-5002 Archer Street I <br /> Alvino,G;A 95502 CAL000187743•(�10)478-1740 � <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street.Santa Cruz,CA 95060.CAD068838222,(0311427-3.773 <br /> * :.EVERGREEN ENV..4139 N.Valentine Ave.•Fresno,CA 93722•CA0982446882•(510)7954400 <br /> .L?f DEMENNOXERDQQ.N •2000 N.Alameda Street-Compton.CA 90222•CAT080013352 e(310)!,537-7100 I <br /> ❑ DIK DIXON•7300 Chevron Way•Dixon,CA 95620.CAT060012602.(701)693-6008 j <br /> ❑ RAMOS ENVIRONMENTAL.1515 S,River Roaq .W:Sapramento,CA 95691 CAD044003556 .(916)371.5747 ►. ) <br /> 177 ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928,CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> USED 011. USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE1TIs 13 to cArtiry that dna above named artiples are propgiiy classified,described,packaged, marked $ <br /> RECYCLED AT OUR SISTER COMPANY DEMENNOlKERDOON THE and labeled,and are in 17roper condition lar ttar�portaton,according to the applicable regulations of r <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the D riment of Trons ort0han. f <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY e p l we� '�f t0` ,. , I <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM.; X 1 I e /L <br /> AND THAT THE WASTE DOES NOT QONTAIN ANY P,C,S'$.. CUSTOMErt SIGNATURE DATE <br /> •I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X ` }`� `�J — . 0 <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR PRINrNAME <br /> CONTAINS ANY PC-B'S. <br />