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SFP-20-2010 09:53A FROM:YANDELL TQIJCKAWAY ,T 2©9835506©------C T^'4683433 P. 10 <br /> FORM NO.AES003 <br /> SERVICE ORDER <br /> tip � w -D NON <br /> 681321 <br /> i <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886 3400 <br /> DIXON UNION CITY <br /> i-800.727-2879 EPA CAD028277036 1-888-403-8844 <br /> DATE ONETIME PICK UP ❑YES or El NO <br /> CUSTOMER �°.. �J. -� �-'` :�. RESIDENCE ❑ YES or El NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT .''.°.,.j � r` CUSTOMER NUMBER <br /> CUSTOMER EPA# C t1 AMOUNT <br /> f r <br /> JOB SITE ADDRESS T ,r,�,•�. i + CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> 1J (AMOUNT) <br /> NOTES: COMMODITY ' r- <br /> HALIDES ``. / r 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)STAlk CODE 133 <br /> 'NO PLACARDS OR MARKINGS REQUIRED' NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. f�r'_� ` F� "� �i '� - NO,OF GALLONS e!''. <br /> DRIVER TRUCK NO.&HT. lc- <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: D BAKERSFIELD TRANSFER INC.-1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831(427.3773 <br /> ❑ EVERGREEN ENV. •4139 N. Valentine Ave . Fresno,CA 93722•CA0982446882• (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 .(918)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827B44 <br /> O ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify th e a named a ides toer Classified,described,packaged, marked i <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeted,and e i pr r condition or tra ccording to the applicable regulailons of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES.' the Department of an or tion. <br /> •1 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 ' I <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CU oME(t SIGNA qE DATE <br /> •I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X - i <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M,TOTAL HALIDES, OR <br /> CONTAINS ANY PC.D'S. " PRINT NAME <br />